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The fear of sex is a type of specific phobia known as erotophobia. This condition is more than just general dislike or feelings of anxiety about sex. People with erotophobia experience severe, intense fear that causes serious distress and interferes with their ability to function normally.

What Is the Fear of Sex?

Erotophobia is a phobia or excessive and irrational fear of sex. This condition is often complex as people with erotophobia may be scared of sex in more than one way. For instance, they may fear the act of sexual intercourse (genophobia) along with having a fear of being touched (haphephobia).

Symptoms of the Fear of Sex

For a fear of sex to rise to the level of becoming a phobia, the fear must be excessive, irrational, create great anxiety or distress, and occur for at least six months. It’s not simply “being scared of sex,” which can be natural—and even expected—in some situations and for some people.

Signs that you or someone you love may have erotophobia include:

• Having a strong negative attitude toward sex
• Having a strong negative response to a sexual stimulus
• Experiencing feelings of avoidance toward sex

Underlying Fears

There are certain underlying fears that, if you have them, may be signs of (or even contribute to) an elevated fear of sex. They are:

• Fear of intimacy: The fear of intimacy is often, though not always, rooted in a fear of abandonment or its twin, the fear of engulfment. Those who fear intimacy are not necessarily afraid of the sex act itself but are afraid of the emotional closeness that it may bring.
• Fear of vulnerability: Like the fear of intimacy, the fear of vulnerability is often tied to a fear of abandonment or fear of engulfment. In this case, people are afraid that if they are totally themselves, others will not like them. Fear of vulnerability can affect all types of relationships, both sexual and non-sexual.

Related Phobias

People with erotophobia can have one or more phobias or fears related to sex. Here are a few to consider.

Genophobia

Also known as coitophobia, genophobia is the fear of sexual intercourse. People with genophobia may be able to begin romantic relationships and may quite enjoy activities such as kissing and cuddling but are afraid to move into a more physical display of affection.

Paraphobia

Paraphobia, or the fear of sexual perversion, can involve a fear of being perverted yourself or a fear of the perversion of others. Additionally, some people with paraphobia are able to enjoy sexual relationships that fit well within their personal moral code, while others are afraid that any form of intimacy might be perverted.

Haphephobia

Also known as chiraptophobia, haphephobia is the fear of being touched and can affect all relationships, not just those of a romantic nature. Some people recoil from even passing contact by a relative, for instance, while others are only afraid of more protracted touch.

Gymnophobia

Gymnophobia, or the fear of nudity, can appear in different ways. Some people are afraid of being naked themselves, others of people being naked around them. This phobia may co-occur with body image issues or feelings of inadequacy, although it can also occur alone.

Philemaphobia

Also known as philematophobia, the fear of kissing can have many causes. One potential cause is a concern over bad breath. Someone with a germ phobia may also develop this fear.

Diagnosis of Erotophobia

To be diagnosed with a phobia like erotophobia, certain criteria must be met. Criteria for a specific phobia diagnosis include:

• Having a marked fear of a specific object or situation that is out of proportion or excessive and occurs for six months or more
• The fear provokes an immediate response most of the time, often leading to avoidance of the situation or increased distress when the situation presents itself
• The fear impacts other areas of the individual’s life, such as socially or professionally
• The fear is not a result of any other mental disorder

What Causes a Fear of Sex?

While it isn’t always easy to pinpoint a specific cause of erotophobia, some people may be at a higher risk of developing this phobia.

Sexual Abuse

Although not everyone with erotophobia has been raped or sexually abused, those who have been traumatized sexually are at increased risk of developing some form of erotophobia.

Other Trauma

People who have been through other types of major traumas also have a higher risk of developing anxiety disorders, including phobias.

If the trauma was physical, for instance, you may develop a touch-related erotophobia. Conversely, those who have been through psychological or emotional abuse may be more likely to develop intimacy or vulnerability fears.

Personal, Cultural, and Religious Mores

Many religions and societies frown on sexual intercourse except for procreation. Research suggests that there is a positive relationship between erotophobia and growing up in a religion with strong ideas around sex and what is appropriate.

Sexual Performance Anxiety

Sometimes, it isn’t actually sex that we fear. Instead, we may worry about our own ability to please a partner. Sexual performance anxiety is very common, affecting up to 25% of men and 16% of women, and can impact physical function during sex or inhibit sexual desire.

Age

Some researchers suggest that older people, such as those in older care homes, may develop erotophobia due to the perception that sex in this age group may be pathological or that it should not occur. This is often referred to as ageist erotophobia.

Physical Concerns

Some people worry that sex will hurt. Others wonder if they will be able to perform due to a physiological condition or sexual dysfunction. These physical concerns can contribute to the development of a sex-related phobia such as erotophobia.

Treatment for Erotophobia

Because erotophobia is so complex, seeking professional help is recommended. This professional can help determine what type of treatment remedies are needed, such as medication and psychotherapy.

Medication

Some practitioners prescribe medications to help reduce erotophobia symptoms in patients. Two drugs that are sometimes used for erotophobia treatment are:

Other drugs for treating specific phobias include antidepressants, monoamine oxidase inhibitors (MAOIs), benzodiazepines, and beta-blockers.

Psychotherapy

Cognitive behavioral therapy can help ease specific phobias. This is a type of psychotherapy that involves identifying and changing thought patterns that negatively impact one’s life.

Sex therapists are licensed mental health professionals who have completed additional training and certification in the treatment of sexual concerns. They can help you cultivate a more positive attitude toward sex.

However, it is not always necessary to seek a sex therapist, as most mental health professionals are capable of treating and managing erotophobia.

Combination Approach

Some patients get better results when combining medication and psychotherapy. When the appropriate avenues are pursued with both of these erotophobia treatment options, the ability to resolve this condition is promising.

Coping With a Fear of Sex

There are some things you can do on your own to help you better cope with erotophobia and its symptoms. For example, relaxation exercises and breathing control exercises can help reduce the anxiety that comes with an elevated fear of sex.

If someone you love has erotophobia, educating yourself about this condition can increase your understanding of what they are going through. If you are their partner, it may even help to attend their counseling sessions (if the therapist agrees and recommends it).

Not all stress is the same. Some of the stress that you face in life can be more detrimental to your well-being, and some types of stress can actually be healthy. One type of beneficial stress is known as eustress.

Eustress refers to stress that leads to a positive response. It is the opposite of distress and can refer to any type of beneficial stress, whether physical or psychological. It tends to be short-term and often feels exciting. People perceive this type of stress as manageable and even motivating.

Physically, eustress can often resemble distress in many ways. You might feel nervous; your heart might pound; your thoughts might race. The difference is how these physical sensations are perceived.

With distress, they may feel uncomfortable and overwhelmed. With eustress, you might feel excitement or a sense of anticipation.

Examples of Eustress

Eustress is associated with positive outcomes. To understand this type of beneficial stress, it can be helpful to consider a few different examples of when it may occur. Unlike distress, eustress is typically associated with feelings of excitement and challenge rather than anxiety or fear.

• Life changes: Major life transitions can create eustress. Examples of changes that can create this type of beneficial stress include starting a new job, being involved in a relationship, and parenting children.
• Smaller challenges: The excitement of a roller-coaster ride, a scary movie, or a fun challenge are all examples of eustress. Even a particularly tough workout can be an example of this type of stress.
• New experiences: Traveling can also create eustress. It can involve significant discomfort and unfamiliarity, but it also provides many discoveries. The anticipation of a first date, the first day at a new job, or other exciting firsts also fall under the umbrella of eustress.

Impact of Eustress

Eustress is a type of stress that is actually important for us to have in our lives. Eustress can have a variety of positive effects. For instance, it may:

• Help you concentrate and focus
• Encourage you to take on new challenges
• Motivate you to pursue your goals,
• Help you feel more resilient in the face of challenges
• Give meaning and purpose to your life
• Help you to feel healthier and happier

A certain amount of stress can be beneficial when it comes to motivation and performance. In fact, the Yerkes-Dodson law suggests that optimal arousal levels (i.e., stress) contribute to improved performance, but only up to a certain point. And different tasks may benefit from different levels of stress and arousal.

Eustress is often thought of as a beneficial type of stress because it can positively impact your life. However, it’s important to remember that eustress is still a type of stress. Because of this, eustress can become distress, or even chronic stress, if it becomes too intense or lasts for too long.

Identify and Respond to Eustress

To manage your stress levels, it is important to recognize the differences between eustress and other types of stress. This isn’t always straightforward because they sometimes resemble each other.

Understanding eustress can help you more easily manage other types of stress as well. For example, research shows that when an event is perceived as a “threat,” people respond to it differently than if it’s seen as a “challenge.”

This understanding can help you evaluate many of the stressors in your life as challenges rather than threats. There are a number of strategies that can help you shift into seeing events as challenges rather than threats:

• Use positive self-talk: This can be done by changing how you talk to yourself about these challenges. Make an effort to tell yourself that these are challenges you can cope with.
• Focus on what you can control: It can also be helpful to focus on the resources that you have to handle these challenges. Focusing on what you can control rather than what might go wrong can help you feel more positive about the challenges you face.
• Adjust your mindset: When you work on shifting your mindset and approach stress as a challenge whenever possible, you can manage these challenges with greater resilience.

Potential Pitfalls

Eustress doesn’t generally carry the same type of damage as chronic stress. Chronic stress is persistent, long-lasting stress that is psychologically or emotionally draining. It is also the most harmful to your health and well-being.

However, too much eustress can still tax your system. You can feel overloaded and stressed by too much eustress if you’re not allowing yourself to return to a relaxed state and have a healthy balance of restorative downtime.

Changing your perspective can certainly help with stress management, but it’s not the only strategy that should be used. If you have too many challenges in your life, even eustress can become chronic stress and lead to burnout or worse. Some ways to deal with this include:

• Being mindful of where your limitations are and work to maintain balance in your life.
• Cutting out any unnecessary obligations (particularly ones that you don’t enjoy).
• Adopting some resilience-promoting habits that can help you to be less reactive to stress overall.
• Becoming comfortable with saying no to new activities if they won’t truly serve you.

This takes practice, but it can make all the difference in your stress levels.

Some people with ADHD struggle to focus (inattentive type), while others have a hard time staying still (hyperactive/impulsive type). For some people, it’s both.

Combined type ADHD is a presentation of attention-deficit hyperactivity disorder characterized by symptoms of both inattention and hyperactivity-impulsivity. To be diagnosed with this type, a person must have six inattention and six hyperactivity-impulsivity symptoms.

Of the three presentations of ADHD, the combined type is the most common. According to some research, approximately 70% of adults with ADHD have the combined type.

Let’s take a closer look at how combined type ADHD is diagnosed and why getting an accurate diagnosis is beneficial. We’ll also explore some treatment options to help people manage inattentive, hyperactive, and impulsive traits.

The 3 Types of ADHD

There are three forms of attention deficit hyperactivity disorder (ADHD). These are:

• Predominantly inattentive ADHD is characterized by problems regulating attention.
• Predominantly hyperactive/impulsive ADHD is characterized by impulsive and hyperactive behavior.
• Combined type ADHD is where both inattention and hyperactivity/impulsivity are present.

These different forms of ADHD used to be called ADHD subtypes. Then, when the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5) was published in 2013, the term “subtype” was changed to “presentation.” For example, a person could be diagnosed with attention deficit hyperactivity disorder, combined presentation.

How Combined Type ADHD Is Diagnosed

All ADHD types are diagnosed in the same way. An experienced healthcare professional performs a detailed evaluation. This clinician gathers information from various sources, including an interview with you (or your child), your medical history, your family medical history, and your school experiences.

The assessment might also include intellectual screening, memory testing, attention and distraction tests, and an interview with your spouse. If a child is being assessed, the child’s parent will most likely be interviewed.

At the end of the evaluation, the clinician will determine if the criteria for ADHD outlined in the DSM-5 have been met. If they have, then a diagnosis of ADHD can be made. You or your child will be diagnosed with an ADHD presentation. This will be either inattentive, hyperactive-impulsive, or combined ADHD.

Following is an adapted version of the 18 symptoms listed in the DSM-5.

Inattentive Symptoms

• Often makes mistakes that appear careless, either at school or work. These mistakes occur because of problems paying attention to details
• Has difficulty maintaining attention on school, work, reading, or fun activities
• Does not appear to listen during conversations, even one on one. Seems internally distracted, for example thinking about other things
• Following through on instructions is challenging. Finishing a task or homework from beginning to end is rare due to getting sidetracked or losing focus
• Tasks are avoided that involve mental effort for long periods of time like schoolwork, work projects, or forms
• Frequently loses items, for example, textbooks, wallet, keys, glasses, and cell phones
• Can be easily distracted by external events
• Is forgetful while doing everyday activities like chores and errands

Hyperactive-Impulsive Symptoms 

• Being physically still is challenging. Will move feet and hands and squirm
• Staying seated is hard. Will often get up and move around, even in situations where sitting down is socially expected, like a classroom or work environment
• Will run or climb at unsuitable times. Teenagers and adults might look physically still but experience internal restlessness
• Rarely participates in hobbies or play activities quietly
• Has lots of energy and is frequently described as “always on the go” or “driven by a motor”
• Talks continually and might be known as a “chatterbox.” This can result in problems at school and work
• Will answer questions before they have been fully asked. Interrupt others while they are talking
• Waiting for a turn is difficult, whether at play, in a line, or during a conversation
• Intrudes on other people’s activities and conversations

Why Getting a Combined Type ADHD Diagnosis Matters

As with many topics, knowledge is power. The more you know about your neurotype and your presentation of ADHD, the more empowered you feel. This, in turn, means you can get the right treatment, accommodations, and support that can help you manage your ADHD characteristics.

Knowing what ADHD presentation you have means you can distinguish between what is an ADHD symptom and what is part of your unique personality. Sometimes, people struggle for years with an aspect of ADHD they think is just part of who they are, only to find later that it is related to ADHD and that treatment is available to help.

In addition to the practical benefits, there are psychological benefits to knowing how ADHD affects you. There is a lot of moral judgment around behaviors that result from having ADHD. For example, being unable to sit still in a meeting might be “disrespectful.”

Understanding the subtleties of your ADHD type helps you to separate yourself from these negative comments and the shame and guilt that comes with them. This frees you to find a proactive solution instead.

What It Means to Have Combined Type ADHD

Having combined type ADHD does not automatically mean your ADHD is more severe compared to someone who is diagnosed with the predominantly hyperactive type or predominantly inattentive type.

For example, a person who has predominantly hyperactive-impulsive type might still experience some symptoms from the inattentive symptom list. However, they would not have the full five or six symptoms to be given a combined ADHD diagnosis. Being diagnosed with combined type ADHD means your symptoms are more likely to be evenly distributed between the two types.

How Combined Type ADHD Progresses Over Time

When the DSM-5 was published, it replaced the term ADHD subtypes with ADHD presentations. This change reflected the new understanding researchers have of ADHD. Rather than being a fixed and stagnant condition that could be neatly divided into subtypes, we now know that a person’s ADHD presentation and severity are more fluid and can change with age and the setting.

People diagnosed with hyperactivity will develop sufficient symptoms related to attention regulation in three to five years. These new symptoms will be strong enough that these people will meet the requirements to be diagnosed with ADHD combined presentation.

For example, a person who experienced hyperactivity as a child and found it hard to sit still might be able to sit still when required as an adult but will feel internal restlessness and discomfort.

Treatments and Support for Combined Type ADHD

If you or your child have combined ADHD, it is important to address both the inattentive and the hyperactive and impulsive symptoms.

ADHD is a form of neurodivergence, which involves a difference in how a person’s brain processes and interprets information. It does not need to be cured, but there are strategies that people can use to help them manage different characteristics of their ADHD.

As with all types of ADHD, the most effective treatment plan for combined ADHD is usually medication plus behavioral treatments like therapy, accommodations, social skills, and lifestyle changes.

Instead, finding the right medication and dose is something that your doctor will be able to help with. You might try several ADHD medications until you find one that helps your ADHD symptoms and has minimal side effects.

You’re the first to text or make plans. Ask how they are or what’s going on in their life. Be there for them. All. The. Time. And, where are they? Nowhere to be found. After a while, you begin wondering if you want to be friends at all.

If you’re the one who’s always giving but never receiving, you might be in a one-sided friendship. It can be hard to see the signs—especially if you’re in the throes of it—but there are ways to 1) recognize this friendship dynamic and 2) stop it from happening. Keep reading to learn more about one-sided friendships, what causes them, and what steps you can take to fix (or sometimes end) the friendship.

Signs of a One-Sided Friendship

One-sided relationships are sometimes easy to spot. But sometimes you might not realize you’re in the midst of one until time has passed.

The first sign of a one-sided friendship is the lack of reciprocity in communication. You’re always the one reaching out first. Other signs you may notice include:

• You feel like you’re always giving but never receiving
• You’re always there for them, but they are absent whenever you need help or support
• They only reach out to you when they need something, whether it’s your time, support, or resources
• You’re the one who initiates all of your conversations
• You always make all of the plans to do things together

According to Seth Eisenberg, a relationship skills coach, one-way relationships are often characterized by a lack of reciprocity and one-way communication. This dynamic can leave you feeling emotionally drained. Rather than feeling uplifted by your friendship, you feel exhausted because you’re always the one giving and never receiving.

If you suspect the friendship might be one-sided, start analyzing your interactions and asking yourself a few questions. Is there a noticeable imbalance in the emotional support you are giving versus receiving? Are you the one who is always listening, helping, and comforting, while they rarely reciprocate?

Another way to assess your friendship is by paying attention to their responses to your problems or accomplishments. In a healthy, balanced friendship, they’ll react enthusiastically and be eager to celebrate your achievements. However, in one-sided friendships, responses will likely involve indifference or jealousy.

“Conversations revolve around your friend’s life, problems, and achievements, with little interest shown in your experiences or feelings,” Eisenberg notes. This type of toxic friendship can hurt your self-esteem and self-worth.

Effects of a One-Sided Friendship

Quality friendships are important for well-being. One-sided friendships, on the other hand, can leave you feeling lonely—which can take a heavy toll on your emotional and mental health. The constant giving without getting anything back in return can drain your energy and make you feel like you don’t have the support you need and crave.

Isolation and Self-Worth Problems

We are naturally social creatures, so social support is vital for our mental well-being. When you don’t have connections—despite your best efforts—you feel isolated, anxious, and sad. You’re questioning why the other person isn’t as committed to the friendship as you are. It can hurt your self-worth and make you wonder why your efforts aren’t being reciprocated.

It May Affect Your Other Relationships

One-sided relationships also pose a risk to your other relationships. If you are emotionally invested in a friend who doesn’t return your efforts, you have less time and energy available for those who do care and support you.

It Can Stifle Personal Growth

Quality friendships can help you grow as a person. In a one-sided friendship, the other person reap all the benefits while you get little or nothing in return. You’re stuck in a cycle where you become the support system for someone else’s growth, but you don’t receive the same opportunities to fulfill your potential.

It Can Hurt Future Relationships

The psychological harm caused by a one-sided friendship can last long after you’ve moved past it, leaving you feeling cynical and skeptical about relationships in general. You may be wary of making new friends and begin creating emotional walls to keep people from hurting you.

This fear can hold you back from forming more healthy, authentic, and mutual friendships. All of which makes it harder to meet new people who might just make wonderful, supportive friends.

Understanding the Dynamics

Why do one-sided friendships happen? Understanding how these relationships form will help you recognize your current situation and help you avoid similar patterns in the future.

Early Attachment Patterns

“From an attachment-based lens, one-sided friendships often occur because of our early relationship experiences,” says Cheryl Groskopf, LMFT, LPCC, an anxiety, trauma, and attachment therapist based in Los Angeles. “If someone grew up feeling they had to earn love or attention, they might overextend themselves in friendships, always giving but never asking for anything in return. This pattern can make them prone to one-sided relationships.”

On the flip side, some people become used to being taken care of without needing to reciprocate, she says. In such cases, they naturally fall into the role of being the receiver in the friendship. “These dynamics create an imbalance where one person feels like they’re constantly putting in the effort while the other just coasts along,” Groskopf adds.

Imbalanced Emotional Labor

Emotional labor refers to mental activity required to manage tasks and maintain relationships. This type of labor includes things like listening to the other person, offering support, planning activities, and working out details to help keep the relationship going.

When the other person doesn’t put in this emotional labor, you are left carrying this mental load on your own. Over time, this imbalance can create feelings of exhaustion and resentment. 

Power Imbalances

If your friend has assumed a dominant role in the relationship, you believe (often subconsciously) you have to bear the burden of carrying the friendship. Being a people-pleaser can complicate this further. Because you want to win their approval and avoid conflict, you may do things to help keep things running smoothly. 

Poor Reciprocity

The principle of reciprocity is important in all types of relationships. While friendships shouldn’t be purely transactional, a solid friendship is rooted in the idea that you will be there for each other. In a healthy friendship, there will be a mutual exchange of kindness, support, favors, and effort. If you are in a one-sided friendship, you probably feel like all you do is give, give, give.  

How to Address a One-Sided Friendship

Being in a one-sided friendship can hurt, and you might be tempted to just walk away. However, there are things you can do to salvage the friendship and steer it toward a healthier balance. Some things you can do to address this type of friendship include the following:

Acknowledge the Problem

The first step is to acknowledge the situation. It’s easy to fall into a pattern and let things just continue as they are. Especially if you’re afraid of rocking the boat. But acknowledging the reality is essential.

Remember, you’re not being overly sensitive or petty. Don’t gaslight yourself into thinking that the problem isn’t real. If you feel constantly undervalued and drained by the friendship, those feelings are valid.

Consider the Dynamic

Once you’ve acknowledged the problem, examine the situation and think about the dynamics playing a role. Do you think your friend is aware of the imbalance? Are they behaving this way intentionally or unintentionally? 

Groskopf says an important first step is to consider the friendship dynamic. “Think about how you and your friend handle relationships,” she suggests. “If you often give too much because you worry about being liked (a classic people-pleasing trait tied to anxious attachment), try to step back a bit. Let your friend know that it’s important for both of you to keep the friendship healthy.”

Have a Conversation

If your friend seems unaware of the problem, it’s worth communicating your feelings to them. The goal isn’t to point fingers or lay blame. Instead, approach this conversation with empathy and assertiveness. Focus on what you are feeling instead of their actions (or lack of actions). 

This conversation can be difficult, but clearly explain how you feel and what steps they can take to help improve the situation. Use “I feel” statements to avoid sounding accusatory and reduce defensiveness.

Request Specific Support

Groskopf also recommends being direct and specific about the type of support you need. “Sometimes friends don’t know what you need unless you tell them,” she explains. “Ask for specific help or support. For instance, ‘Can you check in with me this week? I’ve had a rough time and could use some encouragement.’”

Be Ready to Take Further Steps

Groskopf says assessing and adjusting is essential. “Regularly evaluate the friendship’s balance,” she advises.

If the imbalance continues, Eisenberg suggests it may be time to reconsider your friendship. “Think about the overall value of the friendship,” he recommends. “Does it still bring you joy and fulfillment? If not, it might be time to step back.”

You deserve supportive people who are happy to be there when you need them. And if your friend isn’t giving you that—especially if you’ve asked for it repeatedly—it may be time to cut things off. It’s not easy, of course. Ending a friendship never is. But taking care of yourself means letting some friendships go. This doesn’t mean you’ve failed–it’s a sign of growth and self-respect.

Tips for Ending a One-Sided Friendship

Not all friendships are made to last. Sometimes, a friendship breakup is the best thing for your well-being.

So, what can you do to let go of a one-sided friendship? In many cases, you may simply let the relationship run its natural course once you stop putting in all the effort. Gradually reducing your social interaction and letting the friendship slowly fade is a good option if you don’t want to confront the other person or if you think they might respond in hurtful ways.

Set Boundaries

Once you’ve decided to let go of the relationship, have one more conversation with your friend to explain your boundaries. Let them know they are important to you, but you can’t continue doing all the work. If things are going to continue, they need to make the investment and put forth the effort.

Stop Making Contact

Once you’ve decided to end the friendship, stop reaching out. Don’t text or call. You might miss them and think of them but stick to your resolve.

If the other person reaches out, be willing to hear them out and give them another chance. Maintain boundaries to protect yourself from being taken advantage of again.

Focus on Other Friendships

Even when it is your decision, terminating a friendship is never easy. It’s normal to feel angry, sad, or a range of emotions.

One coping mechanism is dedicating time to your other friendships. They can provide support, reinforce your self-worth, and demonstrate the characteristics of healthy, supportive relationships.

Cultivating Healthy and Balanced Friendships

Great friendships take time and effort. If you want these connections to be strong, give them the time, patience, and attention they need to thrive. But both parties need to be invested in growing and maintaining this link.

What can you do to help build healthier, more balanced friendships in the future?

Remember, It’s About Give and Take

The relationship isn’t going to be 50/50 all of the time. There will be times when you’re giving more, but the same goes for your friend too. It’s OK to go with the ebb-and-flow of the friendship as long as the balance stays fairly equal over time. When you can strike this equilibrium, there’s a better chance that you’ll each feel seen, heard, and valued. 

Talk About Your Friendship

Open communication is also key. If the friendship is becoming unbalanced or if you feel like it’s heading into rocky ground, don’t be afraid to talk about it. Sure, these conversations aren’t the most comforting, but talking openly can help foster greater closeness and authenticity. 

As the friendship grows, remind yourself that you can’t pour from an empty cup. That means making sure you are taking care of yourself. Take the time to do the things you need to stay well, whether that means spending time with other friends, focusing on your interests, or even spending some time alone. Friendships are more likely to feel balanced when each person is at their best.

Narcissistic abuse can involve behaviors such as emotional abuse, gaslighting, manipulation, lying, lack of empathy, and overstepping boundaries. The goal of this abuse is to maintain control.

Healing after you have experienced narcissistic abuse can bring challenges, particularly if you’re sense of self has been damaged by the experience. Fortunately, there are steps you can take to help support your recovery from this type of abuse.

Recovering From Narcissistic Abuse

If you have recently gotten out of a relationship with someone who exhibited narcissistic behavior, it can be hard to know how exactly to move forward in your healing process.

To get some help, Verywell Mind spoke with Mike Dow, PsyD, PhD, a psychotherapist with extensive experience in helping people who have experienced emotional abuse in relationships.

“One of the biggest misconceptions is that all narcissists exhibit a very easy-to-spot grandiosity,” explains Dow. “While many do, there are also those who can appear shy or quiet on the outside, but secretly harbor grandiose plans, negative views of others, and a fragile ego on the inside.”

How to Identify Narcissistic Behavior

Dow explains that narcissists are good at seeking out warm, sensitive people that they feel they can manipulate. If you think that the person you’re with could be a narcissist, Dow says it’s important to ask yourself these questions:

While Dow explains that most narcissists are younger men, he notes that this isn’t always the case. That said, he says there are qualities to look out for.

If you’re wondering if someone you’re interested in is a narcissist, look at their other relationships. If they have a consistent pattern of relationships that were purely transactional or self-serving, that’s a definite sign of narcissism.

“We all want to get our needs met, and that’s healthy,” says Dow. “The difference is that narcissists will throw others under the bus with no guilt if it means their needs are being met.”

Dow says that another way to recognize a narcissist is to notice if they’re constantly looking for praise. He urges his clients to remember that “confidence is quiet while insecurity is loud.”

What Narcissistic Abuse Looks Like in a Relationship

Although narcissistic abuse is not a formally recognized diagnosis, it is often used to describe a syndrome where being in a relationship to a narcissistic partner can adversely affect one’s emotional health. To begin the healing process, first, you have to identify the instances of abuse. This can be harder than it sounds.

Dow says that one of the most damaging aspects of narcissistic relationships is that the narcissistic partner can quickly vacillate between supportive and kind to cruel and manipulative.

Additionally, Dow notes that narcissists need to be in control. They know how to pull you back in after they’ve pushed you too far.

Their goal is to preserve their ego, which can be quite fragile, and these preservation attempts can be both conscious and subconscious.

Ending a Relationship With a Narcissist

If you’re ready to end your relationship. Dow specifies that you should be very clear on why you’re ending the relationship and that you should be prepared for the narcissist to be defensive.

He recommends that the person leaving the relationship go into the conversation with clear talking points about why they’re leaving.

Tips for Healing From Narcissistic Abuse

Dow explains that the primary goal for a person who is healing from narcissistic abuse is often learning to trust themselves again after years of experiencing gaslighting in the relationship. To slowly work back toward learning to trust yourself again, keep these things in mind:

Set Boundaries

After ending the relationship, Dow advises his clients to unfollow or block them on social media, and to be willing to block their phone or emails.

Trust Your Gut

It’s vital that you listen to your own intuition, especially since narcissists have a tendency to attack that in others. “In subtle or overt ways, the narcissist has frequently communicated: ‘What’s wrong with YOU? You’re crazy,'” explains Dow.

Join a Recovery Program

Dow says that relationships with narcissists can commonly trigger co-dependency in their partners. “Co-Dependents Anonymous can sometimes be part of the healing journey,” says Dow. “Especially for people who were previously codependent in other relationships.”

Reach Out to Family and Friends

Make sure that you are surrounding yourself with the loved ones and hobbies that support you and your mental health. Dow explains that one common method of manipulation for narcissists is alienating their partners from their support systems.

Dow calls these support systems “cubby holes,” and advises his clients to work to fill them back up. “Narcissistic abuse typically means you’ve emptied out these cubby holes,” he says. “It’s all about putting yourself together again by returning to your old priorities.”

Growing up with a sibling who had complex needs such as chronic illness or disabilities probably meant you often felt “invisible” to your parents. You knew your siblings needed more help than you, so you learned to take care of yourself at an early age. 

You’re self-sufficient, responsible, and helpful. But you may also struggle with mental health challenges like perfectionism or people-pleasing and find it difficult to set boundaries. If this sounds familiar, you may have grown up as a glass child.

What Is a “Glass Child”?

“Glass child” is not a medical condition or mental health diagnosis, but a colloquial term used to describe certain challenges and strengths experienced by a child who grew up with a high-needs sibling. 

“Glass children learn early on in their lives to meet their own needs and express very little,” she says. “They come across as highly mature and even-tempered. This can be a strength as grown-ups in their life tend to feel positive about their presentation. Unfortunately, this strength is also a vulnerability to the child as it makes it hard for them to reach out when they do need support.”

Emotions Experiences of Being a Glass Child

Angela Pei Wu, LMFT, a life empowerment coach, explains that a child with complex needs has the most power in the family system because they require extra attention and care. “Family members will often adjust and accommodate their own schedules, habits, needs, and way of being for the intensive needs child,” she says.

Resentment and Guilt

An intensive needs child can bring a lot of love and support. However, it is natural for parents or main caregivers to feel burnt out and tired, especially when they neglect their own needs. Or the needs of their other children.

Wu adds that parents are so focused on their complex needs child that they may often forget that their other children also have needs as well. Because of this, some siblings may feel jealous or resentful.

Glass children “may even feel guilty for having negative feelings towards their siblings,” Wu says. “Others may try to make themselves as perfect as possible and not ‘rock the boat.'”

Impact on Mental Health

“Adults who grew up as glass children may have perfectionistic tendencies,” says Wu. Perfectionism is associated with anxiety disorders, depression, obsessive-compulsive disorder (OCD), and eating disorders. Glass children may also struggle with setting boundaries, which can negatively impact their relationships and increase their stress levels. 

The Role of Culture

Wu adds that culture also plays an important component in family relationships. For instance, “in Asian cultures, sibling gender and order informs their family roles. First-born sons and daughters may feel the additional burdens of taking care of their families,” Wu says.

“Traditional gender roles may cause eldest daughters to be their family’s caretakers,” she says. “As [intensive] needs is a taboo topic in Asian culture, families may feel the need to “save face” or hide the [complex] needs child due to shame. This causes families to be less likely to ask for support, putting an additional burden on the family system.”

Coping Strategies for Glass Children

There are several ways to cope if you identify as a glass child. When a child has buried their needs on behalf of the family, it’s important they learn how to openly express themselves, says Harwood. This can be a challenge for a glass child who has coped primarily through shrinking and minimizing their feelings and needs. 

Learn To Express Their Needs

Harwood suggests glass children use creative hand signals to help them communicate their needs. Or, write their feelings in a journal. “We want them to learn to take up space and reach for us even when their needs feel small in comparison with a higher needs sibling,” says Harwood.

Identify and Recognize Unhealthy Patterns 

For those who grew up as glass children, it’s crucial to recognize unhealthy behaviors such as perfectionism and people-pleasing.

Some patterns include:

• Feeling the need to put themselves last
• Feeling responsible for things out of their control
• Having poor boundaries
• Overworking
• Being overly critical of themselves

“Once these behaviors and patterns that are not beneficial are identified, glass children can work toward setting boundaries, identifying and honoring their needs, developing self-affirming language, and releasing themselves from things outside of their control,” Wu says.

Parenting a Glass Child

If you are a parent of a glass child, you may be worried that you are causing these negative experiences. It’s important to recognize the needs and emotions of glass children and create a supportive and inclusive environment that provides attention, care, and resources for each child.

Recognizing Needs

Harwood says the first step to recognizing the needs of a glass child is to take the time to check in with them. Ask about their feelings and emotions and listen with presence and attention when they respond. This helps them learn that they and their needs are valid and important.

Pay Attention To Subtle Cues

Harwood emphasizes the need for parents to pay attention to the subtle emotional cues of their glass child. Glass children may not express needs in overt ways, but there are small signs that indicate emotional distress. For example, notice when they quietly leave a room or turn their faces away or down during a tense moment. 

“The more we attune to [a glass child’s] emotional state, the more likely it will be that we start to understand what they need,” Harwood says.

Support Groups

Harwood also suggests finding support groups for children with high-needs siblings. These support systems can become safe, understanding, and compassionate spaces for glass children to express their feelings and relate to one another.

Sibling Relationships and Glass Children

Wu adds that the experience of having a sibling with intensive needs can cause a myriad of emotions towards their sibling “such as love, joy, worry, fear, guilt, and maybe even resentment.”

Parentification

Glass children can often feel the responsibility for their complex needs sibling, which can lead to them being very mature, responsible, and even parentified.

Wu defines parentification as a child taking on parental duties for their siblings or parents. “Parentification develops when children perceive their parents as too overwhelmed or incapable of fulfilling their parental duties. When this happens, parentified children become ‘little adults‘ to help alleviate the family burden,” she says.

In a case where a family has a high-needs child, parents may unintentionally cause parentification by reinforcing the child’s caregiving qualities, Wu says.

“Glass children learn that to be ‘good’ is to put their siblings before themselves,” Wu says, minimizing their own needs, which can build resentment towards siblings and parents. “These caretaking siblings develop people-pleasing tendencies which may affect them into adulthood,” she adds.

Resources and Support for Glass Children and Families

Harwood says glass children need attuned and connected parents who remember to prioritize their needs, despite the high needs of another child. “The best resource for a glass child is a secure attachment with at least one of their parents,” she adds.

Recommended Books

Harwood recommends the following books for glass children and their parents:

• For parents and older glass children: ”Living with a Brother or Sister with Special Needs: A Book for Sibs“ by Donald Meyer and Patricia F. Vadasy
• For teen glass children: ”The Sibling Survival Guide: Indispensable Information for Brothers and Sisters of Adults With Disabilities“ by Don Meyer 
• For younger children: “I am Just as Special: How to be a Sibling of a Special Needs Child” by Lena Hanna