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Explore and evaluate worries using a writing technique that leaves you calmer. Key points Listen to your worries; do not shut them out. Admit whatever is true. At the same time, do not automatically believe a worry. See if the worry stands up to questioning. In a two-column table with rows, write worries in the left column and evaluate them in the right column. Wouldn’t it be great if you could simply tell your brain not to worry? Unfortunately, that doesn’t work. So, let’s quickly review three skills that do work, then learn a powerful written approach to explore worries without getting more anxious. Man running at the beach Skill #1: Worry Time If an upsetting worry keeps popping into your mind over and over, regain mental peace by scheduling a daily worry time. "9 Steps to Keep Worry From Hijacking Your Brain" explains how to do this and why it works. Skill #2: The Three A’s of Adaptive Worry Even the most upsetting worries are well-intentioned. The primitive “reacting brain” amygdala triggers worry to alert you to threat and danger. Sometimes worry is adaptive and helpful. Learn the "3 Ways to Tell if Worry Is Helpful." Helpful worries are accurate, motivate you to take appropriate action, and then go away. Skill #3: False Alarm Warning Signs Because the brain’s threat response system is automatic, it can send false alarms. Spot the”5 Signs that Worry Is Not Helpful.” Be skeptical if worry says: “What if…?”: focuses only on what could go wrong. “Are you sure?”: wants guaranteed safety or total certainty. “Danger is likely; you can’t cope”: overestimates the likelihood of danger and underestimates your resilience and ability to cope. “This time is different!”: disregards the fact that past worries were wrong. “Keep reacting to lessons from the past”: ignores that your life has changed. Make Worry Your Ally, Not Your Enemy You don’t control what worries enter your mind. You do control how you respond to these worries. Since worry is trying to be helpful, start by really listening to what worry is saying. Are you worried about your grades, job, career, or finances? Your relationship or lack of one? Your health, climate change, the future? Your parents, children, or grandchildren? What else? Now use writing to explore and question these worries. Create a table with two columns and several rows. Label the left column “Worries, Fears, Distressing Thoughts.” In this column, write only one worry per row. Putting worries into writing slows the worry process so you don’t spiral. Write specifically what worry says is going to happen. Label the right column “Facts, Evidence, Logic, Perspective.” In this column, objectively evaluate what the worry is telling you. Is worry alerting you to an unsolved problem—or sending a false alarm? Write the answers to questions like: What does worry predict will happen? How often has it predicted this? How often has what it predicted actually happened? Be Curious—But Not Credulous Listen carefully and attentively, but do not automatically believe what each worry says. Compare it against the facts. Write what you would tell a friend, child, or mentee who said what the worry says. Put things in perspective. Question and evaluate each worry in an unbiased, unemotional, objective way. If what the worry says is true, your experience and logic will agree. For example, if you wrote in the left column “I’m worried I’ll get a bad grade on this test” and you wrote in the right column “I haven’t studied, I don’t understand the material, and I got D’s on the past two tests,” facts support the worry. On the other hand, if you wrote in the right column, “I'm worried I'll get a bad grade on this test. Worry always says I’ll get a bad grade. It said it for the last 60 tests I took in 12 classes. I’ve never gotten less than a B,” the facts do not support the worry. Fears vs. Facts Dialogue Writing I call this two-column writing “fears vs. facts dialogue writing." Creating dialogue tables engages both levels of your brain: the lower, more primitive, amygdala “reacting brain” that produces the worries, anxiety, and fear and the higher, smarter, more developed cerebral cortex “thinking brain” that can question and evaluate worries and fears. The dialogue table is the most flexible and powerful tool I know for worry and fears. By creating a partnership allowing both parts of the brain to “talk” to each other through writing, you listen to your worries without fearing or fighting them. You neither believe worries without proof, nor dismiss worries without thought. In the posts that follow, I will share real-life examples of dialogue tables, tips on effectively uncovering worry’s hidden assumptions, and tricks to discover whether a worry is true, partly true, or plausible but false. Elizabeth McMahon, Ph.D. -Blog

ADHD can have widespread impacts unless meticulously addressed. Key points ADHD is a proven medical disorder with widespread impact. Undermanaged ADHD has been linked to health risks, substance abuse, driving accidents, and more. ADHD medication has been used for nearly a century and been shown to be both safe and effective. Using ADHD medications without side effects is possible for most people when they are managed well. No one I talk to is happy with the state of health care. Doctors feel disempowered and pressured and do not have the time they want to spend with patients. And anyone who goes to see doctors feels about the same as they try to advocate for themselves. At the national ADHD conference, for example, a theme arises: How can I even talk to my provider about my ADHD? ADHD is not a highly emphasized part of medical training—and it takes time to discuss the details. Rushed visits leave people struggling to communicate and feeling frustrated. One of the greatest frustrations, for them and for me, is the under-management of ADHD medications. There is rampant judgment around taking them but there is also a large amount of misinformation, both online and in the community, about what the drugs do and do not do. ADHD medication should be discussed like any other medication. It’s unfair and unfortunate for people with ADHD that these safe and proven treatments have been stigmatized. Since much of the misunderstanding arises from how they are managed, what follows is a path toward skillful and kind medication management in two parts. Part One: The Bare Facts ADHD is a confirmed medical disorder when correctly diagnosed. The easiest way to understand this may be that the genetics of ADHD are nearly as strong as the genetics of height. ADHD medication has been used for around a century. After a hundred years of use there are no known long-term side effects. Robust longitudinal studies have shown, for example, no concern about growth. The medications appear to decrease the risk of substance abuse for someone with ADHD. They also do not change personality or limit creativity when properly prescribed. ADHD medications work by activating the parts of the brain that are underactive when you have ADHD. This is the end point for both groups of ADHD medications, stimulants and non-stimulants, in spite of their confusing names. The strong benefits of ADHD medication for individuals with ADHD have been shown across numerous studies. Between 80 and 90 percent of people can use these drugs without significant side effects when managed well. Recent studies show not only academic benefits but potential improvements related to lifespan, risk of substance use, and even criminal behavior. Since the medication is in and out of the body rapidly, if someone encounters a side effect and stops taking a medication, that side effect should resolve quickly. The bottom line message about ADHD medications is this: No one should use a medication they do not need for anything in life, but no one should feel judged or scared about trying ADHD medication. Part Two: Skillful Medication Management The goal for ADHD medication is to end up with benefits and no significant side effects; getting there relies entirely on trial and error. There is no predicting what medication or dose will work for any individual. If a website or person is suggesting a single medication as best for all, they’re giving bad advice. Stimulants have immediate effect, in terms of both benefits and side effects. There is no point monitoring long-term before making adjustments. Non stimulants take a little longer to reach peak effects, but quick adjustments are still possible. The ups and downs of life can confuse the picture, but after a week or two, little is likely to change. The trial-and-error period can be difficult but keep moving until satisfied. Side effects are manageable unless someone falls into the small group of people who do not tolerate medication. However, it is common to try multiple medications, at various doses, or combinations of medications, before finding what feels right. Start the trial-ans-error by tracking medication benefits. Focus, hyperactivity, and impulsiveness should no longer be disruptive once medication is working well. As dosing is not weight-based, as soon as the impact of a dose is clear, adjustments can be made. If the effects are not clear, various ADHD rating scales are available to track progress in a more structured way. Track side effects. The goal is, again, no significant negatives. Mild side effects do sometimes resolve, so they can be monitored for a short time before making a choice. If there are persistent concerns, then either the medication can be changed or the dose lowered. Right away. Always. The intention of medication is to cover a person’s entire functional day, seven days a week. This includes more than school or work hours but homework, family time, chores, and hobbies as well. Since larger doses do not make medication last longer, only changes in formulations or booster doses will improve length of effect. The achievable goal for most individuals with ADHD is to feel completely themselves, better focused, and more on top of their life. ADHD medications are proven and safe medications when used appropriately, in spite of misinformation that suggests otherwise. There is no reason to accept limited benefits or ongoing side effects. In spite of all the pressures of modern medicine, time-related and otherwise, successful ADHD management relies on frequent follow-up and effective communication between patients and providers. When this happens, people with ADHD can expect a safe, effective treatment and to live their lives in line with their best intentions, meeting their full potential. Mark Bertin, M.D. -Blog

What research reveals about trauma and body-focused repetitive behaviors. Key points There is no demonstrated causal link between trauma and BFRBs. Individuals with trauma histories can experience BFRBs. BFRB treatment centers around building a fund of healthy self-regulation and self-care strategies. Women plucking eyebrows When the causes of body-focused repetitive behaviors (BFRBs), such as hair pulling (trichotillomania), skin picking (excoriation disorder), or nail biting, are discussed, the question often arises: Are these behaviors caused by trauma? It’s a fair question. The assumption makes intuitive sense. Many behaviors that cause physical harm or distress are linked to emotional pain or traumatic experiences. However, the science paints a more nuanced picture. What Research Reveals (and Doesn’t) Empirical studies exploring trauma histories among individuals with body-focused repetitive behaviors (BFRBs) have produced mixed, but generally nonsupportive, findings regarding a causal link. Early work by Christenson and Crow (1996) found childhood trauma rates among people with trichotillomania to be similar to those observed in the general population. In contrast, Özten et al. (2015) reported somewhat higher trauma exposure among individuals with trichotillomania and skin-picking disorder compared to controls, yet trauma history was not predictive of symptom severity, suggesting correlation rather than causation. Similarly, Houghton et al. (2016) conducted a large-scale analysis and concluded that the association between trauma and trichotillomania is “tenuous at best.” A broader review by Roberts, O’Connor, and Bélanger (2013) emphasized that habit-based and neurobehavioral mechanisms, rather than trauma pathways, best explain BFRB development and maintenance. Collectively, these findings indicate that while trauma may be present in some individuals with BFRBs, it is neither necessary nor sufficient for their emergence. So, What Does Drive BFRBs? BFRBs are better understood as repetitive behaviors targeting the hair, skin, or nails, that develop and persist because they temporarily regulate internal states. Neurologically, these behaviors are tied to the reward and habit circuits of the brain, particularly those involving dopamine and the basal ganglia (Fineberg et al., 2010). In a comprehensive review, Grant and Chamberlain (2016) noted that the neurobiological and behavioral mechanisms underlying BFRBs are distinct from those of trauma-related disorders. This is consistent with growing evidence that BFRBs share features with habit and reward system dysregulation, rather than with posttraumatic symptom patterns. Understood from a functional behavioral perspective, pulling, picking, or biting typically provides an immediate, momentary sense of relief or gratification, reinforcing the behavior. Over time, this creates a feedback loop (an antecedent urge, the behavior, and short-term relief). The more the loop repeats, the more automatic it becomes. And for many people, these behaviors can even occur outside of conscious awareness. When Trauma and BFRBs Coexist That said, trauma and BFRBs can co-occur and can overlap in complex ways. Trauma may influence how someone experiences antecedents and/or how they manage stress/distress. For example, someone with a trauma history may feel heightened shame, self-blame, or fear around their BFRB and may have a more difficult time managing these thoughts and feelings. Emotional sensitivity and emotional dysregulation, both of which can stem from trauma, can also exacerbate BFRB symptoms. So while trauma doesn’t cause these behaviors, it can contribute to its maintenance. Why the Distinction Matters When clinicians assume that a BFRB must be related to significant trauma, treatment can veer in an unhelpful direction. Individuals may spend years exploring “why” rather than learning “how” to better manage the behavior. Evidence-based behavioral therapies focus on increasing awareness, understanding antecedent triggers, and building adaptive skills and strategies for healthy self-regulation and self-care. For some, trauma and BFRBs share space; for others, they do not. Either way, the path to living a life unfettered by one’s BFRB involves understanding one’s experiences in the context of their own internal world (thoughts, emotions, sensations/urges) and learning new ways to respond to it. Marla Deibler, Psy.D., ABPP -Blog

Researchers find a genetic basis for sexlessness. Key points One percent of the population has never had a sexual experience. Genes associated with intelligence are linked to sexlessness. Sexlessness was associated with less imbibing of alcohol, not smoking cigarettes, and not using cannabis. "Sex is like money; only too much is enough." –John Updike. That may be true generally, but not everyone is wealthy, and some people never have sex. One percent of the adult population has never had any form of sexual experience. A new study finds that a reason for this is not in their jeans—it is in their genes. Woman lying on grass The study by researchers at Princeton University analyzed the genes of 400,000 people in the United Kingdom between the ages of 39 and 73 and 13,500 Australians, aged 18-89. They sifted through the data to find people who have never had any type of sexual experience with the same or opposite sex. This left them with a dataset of 2,068 sexless females and 1,861 sexless males. What they found is surprising. Talk Nerdy to Me, a Turn On? Sexual behavior is complex, and many factors are involved, but the study found a cluster of genetic variants that was strongly associated with having never had sex. Prominent among these are genes associated with intelligence. If you presumed that genes producing brighter brains drive brighter bedroom activity, you would be as surprised as the researchers were. The opposite effect was found. Genetic associations with higher childhood IQ and higher education correlate with sexlessness in adulthood. The genes that boost cognitive function, and their associated traits, are also correlated with higher income and socioeconomic status. This puzzling finding applied equally to both sexless males and sexless females. This negative correlation between smarts and sex seems counterintuitive from the perspective of natural selection in mating choices, which would seem to place a premium on mates with higher intelligence and richer resources. As the authors explain, “Obvious explanations for [this]…are not apparent to us.” It seems that some aspects of human nature, the facts of life among them, remain elusive to the facts of science. In correlating the genetic variants of sexless individuals with other factors, the researchers conclude that being nerdy negates opportunities for nookie. Having weaker physical strength, which they measured by grip strength, punier arm muscles, and wearing glasses at an early age, were associated with sexlessness in men. Wearing glasses as adults had no effect on sexlessness. Focus groups reported that sexless individuals with these genetic traits had experienced being called “nerds” and “geeks” as adolescents, and they perceived this as being unattractive. Everyone Looks Good at Closing Time Sex and alcohol go hand in hand. Couples meet at a cocktail bar. Alcohol, being a powerful solvent, dissolves inhibitions. Consistent with alcohol as an aphrodisiac, the study found that sexlessness was associated with less imbibing of alcohol, not smoking cigarettes, and not using cannabis. Engaging in these addictive behaviors is associated with genetic variations that promote risk-taking and pleasure seeking. A weaker drive for adventurous engagements may make people more reluctant to play the mating game. Sexlessness was also correlated with genetic variations associated with low extraversion. This would tend to make people less likely to engage in social situations, often where alcohol is served, where they could meet potential sexual partners. Psychological Conditions Other genetic variants associated with various psychological disorders were also associated with sexlessness. It is not surprising that certain conditions could make finding mates more difficult. Gene variants associated with attention-deficit/hyperactivity disorder, autism spectrum disorder, and posttraumatic stress disorder were correlated with sexlessness. Poor mental well-being can make attracting potential sexual partners more difficult, but genetic variants that predispose people to major depressive disorder and anxiety were negatively associated with sexlessness. It is important to note that while the study reveals that there is a genetic predisposition to sexlessness, this only explains a small part of the reasons why people are sexless. Another factor that the study identified was men living in a region with fewer women. Sexlessness was also more prevalent in regions with higher income inequality. Moreover, sexual behavior is a personal choice, and while the study finds greater levels of unhappiness in the population of sexless individuals, some may simply prefer that lifestyle. In a nutshell, the study shows that genes and environment influence having a lifetime without sex, but a brighter brain can put a cold shower on sex. R. Douglas Fields, Ph.D. -blog

Understanding DMDD and the silent struggles of explosive children Key points Don’t push kids to talk—meet them where they are. Focus on control, not conflict. Future planning works better than past digging. Over the years, more and more parents have walked into my office describing a similar, challenging pattern in their children—kids who don’t just get upset but explode. They have quick tempers, intense emotional reactions, and rigid thinking. They can’t bounce back quickly once triggered, and the minor issue—a sibling touching the remote or a favorite shirt in the wash—can lead to full-blown meltdowns. Child playing with blocks These children were once labeled everything from ADHD to early signs of bipolar disorder or intermittent explosive disorder. Dr. Ross Greene aptly called them explosive. But we now have a better understanding: Many of these children are dealing with disruptive mood dysregulation disorder (DMDD), a mood disorder characterized by severe irritability and frequent, intense temper outbursts (Goldstein, 2024). What Is DMDD? DMDD is a relatively new diagnosis, officially recognized in the DSM-5 in 2013. It was developed to more accurately categorize children who don’t fit cleanly into other disorders like pediatric bipolar disorder or standard ADHD. These children experience: Severe recurrent temper outbursts, verbal or behavioral, that are grossly disproportionate to the situation Chronic irritability or anger that is present most of the day, nearly every day Difficulty regulating emotions, especially when frustrated or disappointed These are not occasional tantrums. This persistent pattern interferes with daily life, friendships, school functioning, and family dynamics. The hardest part? These children often can’t talk about what’s going on. Why They Won’t Talk As therapists, we’re trained to expect that if we show up with empathy, patience, and good questions, kids will open up. We assume that once we gain their trust, they’ll tell us what’s going on so we can help them learn how to manage their anger or anxiety. That approach works for many children. But with kids who have DMDD, it often falls flat. These kids don’t talk. Not because they’re defiant or oppositional, but because they genuinely can’t. They don’t understand what set them off. They don’t know when the next outburst is coming. And when they aren’t upset, they don’t want to go near those feelings. As one child put it: “I never know when I will get upset or what will upset me. I never know how long I’m going to be upset. So, when I’m feeling good, I don’t want to talk about feeling bad because maybe even that will make me feel bad." This kind of emotional whiplash makes sense of their silence. For them, talking about outbursts feels dangerous, like a trapdoor back into chaos. Avoidance becomes a form of emotional self-protection. A Better Way Forward I changed my approach once I started to see this pattern more clearly. Rather than pushing these children to relive what upset them, I started focusing on what helps them feel in control. Instead of probing into the past, I shifted the conversation to the future. We discuss this model in depth in our new book, Raising Resilient Children With Disruptive Mood Dysregulation Disorder. “What might help you feel more in control the next time something unexpected happens?” I ask. That future-focused lens and a few more key shifts made a real difference. Here’s what I learned: When they’re upset, don’t talk. Just support them. Verbal processing is useless in the moment of a meltdown. What helps is a calming presence, gentle redirection, and clear boundaries. When they’re calm, don’t dig—build. Focus on building confidence in their self-regulation. Avoid rehashing past blowups. Instead, role-play possible future situations or devise “control plans” together. Help parents shift their expectations. These kids aren’t trying to be difficult; they’re overwhelmed. Parents need tools for prevention, not punishment—structure, routine, and patience. One Family’s Story I remember working with a 9-year-old boy. Let’s call him Evan. His parents were at their wits’ end. Evan had daily meltdowns over seemingly minor issues. One afternoon, he kicked a hole in the wall because his cereal bowl was the wrong color. His parents had tried everything: therapy, charts, and consequences. Nothing worked, and he wouldn’t talk during sessions. When I met Evan, he was polite but distant. He looked at his shoes more than me. In the first few sessions, we barely spoke. I gave him a marker and let him draw. Eventually, I asked him what made him feel strong and in control, not what made him mad. That changed everything. Over the weeks, we built a “control kit” together. It contained his own list of calming tools, a drawing of his “cool brain,” and even a superhero name he gave himself when he could stay calm in tough situations. His parents also learned new ways to respond—less focused on punishment and more on prevention. It didn’t “fix” everything. He still had tough days. But now he had words for those days. And more importantly, he had hope that he wasn’t just broken. Sam Goldstein, Ph.D. -blog

How to manage self-doubt and learn to embrace your achievements. Key points Imposter syndrome is a distortion of reality that, if not checked, can be debilitating. Taking a realistic inventory of your life, your sacrifices, and accomplishments can help. Perfectionists often are the first to distort their own perceptions. Shakespeare once wrote, “All the world’s a stage, and all the men and women merely players.” He wasn’t just being poetic; he was capturing a truth about human behavior: Life requires us to play roles. We shift from child to student, from lover to leader, from novice to expert. And with each role comes expectation, scrutiny, and, sometimes, self-doubt. A nervous man sits at a table during what appears to be a job interview or serious meeting. Looking back on my own decades in life—student, waiter, pilot, FBI agent, graduate student, author, speaker—I can honestly say I’ve felt like an imposter at nearly every stage. From my first solo flight in a Cessna 152 at 17 to my first arrest of human traffickers in the Sonoran Desert, miles from any help, I often wondered, Do I belong here? Am I ready? Even as I rose through the ranks, I sometimes asked myself: Did I earn this, or am I fooling everyone? That gnawing, persistent doubt has a name: imposter syndrome. Millions of high-achieving individuals live under its shadow, convinced that their success is a fluke and fearing the day they’ll be “found out.” The Inner Mechanics of Imposter Syndrome At its core, imposter syndrome is a misperception of self. It convinces capable, accomplished people that their achievements are undeserved. Luck, timing, or help from others—never their skill, effort, or preparation—becomes the story of their success. Here are some patterns I’ve observed in those who struggle with it: Introspection turned inward: Highly self-aware individuals constantly analyze their performance—and compare themselves to others, often unrealistically. Perfectionistic standards: Anything less than flawless feels like failure. Mistakes aren’t learning opportunities—they’re proof they don’t belong. Discounting accomplishments: They minimize the effort, sacrifice, and skill that contributed to their achievements. Fear of exposure: They dread that someone will “catch on” and reveal them as frauds. Over-preparation and overwork: They arrive early, take on extra tasks, and rehearse endlessly to avoid scrutiny, even for minor things. These aren’t weaknesses; they’re signs of hyper-vigilance, the same drive that makes people meticulous, reliable, and effective. But when turned inward, this vigilance becomes self-sabotaging, even debilitating if unchecked. Unfortunately, in my experience, minorities, women, and people of color seem to fall victim to this far too often, leaving them in self-doubt. Behavioral Clues: What the Body Tells Us One of the things I’ve learned in decades of studying nonverbal behavior is that the body often speaks before the mind does. People experiencing imposter syndrome leak subtle clues: Reluctance to participate in meetings or events. Self-soothing gestures: Touching the neck, rubbing hands, or stroking the face when stressed or under scrutiny. Constricted posture: Sitting hunched, taking up less space, almost as if to disappear. Brief avoidance of eye contact: Small, fleeting breaks in gaze during presentations or conversations about accomplishments, seemingly wanting to hide in the open. Over-compensatory behaviors: Arriving early, bringing exhaustive notes, rehearsing unnecessarily. Individually, these actions aren’t diagnostic. But in context, especially alongside verbal expressions of self-doubt, they reveal a persistent internal struggle. Why High Achievers Are Most Vulnerable Paradoxically, imposter syndrome tends to strike the most competent and conscientious people. High performers push themselves, set high expectations, and rise quickly—but each success becomes a new hurdle. Achievement feels less like proof of ability and more like evidence that the world’s about to discover they’re unqualified. Comparing yourself to others, add a competitive environment, sprinkle in stress, and the result is chronic self-doubt—despite an impressive track record of accomplishments. Breaking the Cycle Imposter syndrome isn’t eliminated; it’s managed. The goal is to realign perception with reality. Some strategies that work: Name it: Simply acknowledging “This is imposter syndrome” weakens its hold in my experience. Document your achievements: Keep a record of accomplishments, praise, and moments of competence. Keep an up-to-date and accurate CV, and review it when doubt creeps in. Reframe mistakes: Mistakes aren’t proof of inadequacy—they’re feedback. High performers err because they try. Talk about it: Sharing feelings with peers or mentors often reveals that others feel the same way. Separate feelings from facts: Feeling like a fraud isn’t the same as being one. Adjust expectations: Aim for excellence, not perfection. Track triggers: Notice when feelings of doubt arise—meetings, presentations, or evaluations—and prepare strategies to manage them. For me, it was often when confronted with a new challenge, and I was on my own. Seek unbiased assessment: Have someone you trust who knows how hard you have worked and all that you have sacrificed give you a realistic assessment of what you have achieved. A Final Thought An old saying goes, “We judge ourselves by our doubts and others by their accomplishments.” That’s imposter syndrome in a nutshell. Even the most accomplished people I have had the pleasure of knowing and working with confessed privately to feeling like frauds at times. You are not here by accident. Your achievements reflect effort, skill, hard work, sacrifices made, and resilience. Let your inner critic remind you to stay sharp—but never to doubt your worth. It means you care deeply about getting it right. In fact, what I found was that only the people who really care, who really strive, were the ones who reported the imposter syndrome. You never heard that from marginal employees, or at least I never have. The key is not to silence that inner voice entirely, but to put it in its proper place. Let it remind you to stay sharp, but not to doubt your worth. The mask of competence you wear is not a disguise. It is simply the outer layer of a truth that has been there all along. Joe Navarro M.A. -Blog

Personal Perspective: Is retirement a social death or a rebirth? Key points Retirement carries a risk of what sociologists call social death. Social death is not inevitable. Remaining socially engaged is the key to flourishing in retirement. Social death can be turned into social rebirth, setting the occasion for a meaningful retirement. At the end of August of this year, following a long (45 years) and rewarding career as a college professor, I retired from my position of Professor of Engineering Psychology at the United States Military Academy. During my decades in higher education, I had the privilege of teaching and mentoring thousands of undergraduate students, engaged in a variety of stimulating research projects, and participated in a important community service for my institution and my profession. I could not have asked for a better career. Elderly man looking out the window My decision to retire was not a quick one nor did I arrive at it without substantial thought. My work was a source of meaning and purpose in my life, and I knew that leaving that behind would be a challenge. I readily acknowledge and am grateful to have had a profession that was so rewarding and therefore hard to step away from. Plenty of people – maybe the majority – do not enjoy the luxury of such a situation. Social Death One of my colleagues and close friends at West Point, sociologist Morten Ender, and I often engaged in discussions about retiring. Morten pointed out that retirement may pose the risk of social death. That gave me pause because there is truth in what he says. Most of my social interactions over the past five decades have revolved one way or another around my job. The daily give and take in the classroom with students provided social stimulation. Research collaborations and hallway or office chats with colleagues did the same. My department at West Point sponsored regular social events, ranging from football tailgates to formal dinner gatherings. Stepping away from this certainly seemed like a form of social death. My department at West Point gave me a grand farewell. There were speeches by colleagues and current and former students. They gave me plenty of mementos to adorn the walls of my home office. It didn’t take long for an indicator of social death to occur. I was taken off the department’s email distribution list. To be sure, I complained as much as anyone about the volume of administrative emails emanating from the department’s leadership. But I wasn’t prepared for the impact that a total absence of information about department operations would have on my situational awareness and connectedness to former associates. I was not informed about four of my colleagues who were selected for long-term faculty positions in the department. Nor was I told who was selected to be our next department head. I only learned about these events indirectly from former colleagues who passed along the information informally. This made me feel disconnected. Social Rebirth So, in some ways Morten was right. Two months into my retirement, I do miss the personal and social engagements offered by full-time teaching. But social death is not inevitable. There are other ways of filling this very basic human need. Here are some steps I have taken: Actively seek out new social relationships. Now that I am retired, I can nurture and savor social relationships that I had less time to enjoy previously. Spending time visiting with neighbors and engaging with friends from past eras of my life are two ways to do this. Learn to draw upon your personal virtues and character strengths to provide meaning and purpose. Following Peterson and Seligman’s Values-in-Action categorization of character strengths and virtues, I find myself shifting from virtues important to my professional success (mostly the virtues of wisdom and courage) to those important in other aspects of life (mostly the virtues of humanity, transcendence, and temperance). By doing so, one can discover new ways of finding meaning and purpose in the post-retirement years. Find ways to remain involved in your profession. After retiring, I accepted a visiting professorship at England’s Buckinghamshire New University. In this role, I offer occasional lectures and mentor graduate students. The workload is minimal, but it maintains my professional identity and maintains a sense of self-worth. Remain intellectually engaged. I have submitted a book proposal and continue to author this blog. I am less interested in conducting and publishing basic research and more interested in synthesizing what I have learned in my decades as a psychologist and sharing it in forms that others may easily digest and appreciate. Maintain or increase your physical activity. Exercise helps maintain brain health. Moreover, many forms of exercise include social interactions. I walk several miles a day around town, stopping to visit friends and neighbors. Take up a new sport (pickleball, anyone?!), join a bike or running club, or go to the gym several times a week. Your physical health and social health will improve. Be grateful for the past and optimistic for the future. Nothing lasts forever. I am proud of my accomplishments but excited to see how my post-retirement life unfolds. It Is Your Choice The surest way to turn retirement into social death is to become a couch potato. Watching television, surfing the internet, or following social media day in and day out does not provide the level of social engagement and physical fitness needed to flourish in your retirement years. Social rebirth, then, requires effort. The good life, whether working or retired, requires engagement, meaning, and purpose. There are many ways to achieve this and with thought and effort, everyone may develop a plan to ensure that retirement is indeed a rebirth and not a spiral into oblivion. Michael D. Matthews, Ph.D. -Blog

Why PMDD deserves more attention in the conversation about women's mental health. Key points PMDD affects roughly 1 in 20 women of reproductive age and is often misdiagnosed or dismissed. Symptoms can include severe mood swings, depression, anxiety, and even suicidal thoughts. Effective treatment can include a combination of lifestyle changes, therapy, and medication. Increasing awareness and research funding for PMDD is essential to improve diagnosis and care. Graph with stressed, sweating woman After centuries of being overlooked, dismissed, or outright pathologized, women’s health is finally getting a little more of the attention it deserves. In recent years, conversations around perimenopause have begun to shift from whispered frustrations to mainstream headlines, thanks in part to advocates like Halle Berry, Drew Barrymore, and Oprah Winfrey. And as more research dollars are allocated to understanding the complexities of women’s physical and mental health, we’re starting to connect the dots in ways that matter. But there’s another “P” word in women’s health that still lives too far in the shadows: PMDD. Premenstrual Dysphoric Disorder is not just “bad PMS.” It’s a severe and often debilitating mood disorder that affects up to 1 in 20 women of reproductive age, yet it’s still wildly underdiagnosed and frequently misunderstood, even in clinical settings. As a psychotherapist and group practice owner, we’ve sat with clients who describe monthly cycles of despair, irritability that threatens their relationships, and anxiety so intense it disrupts their ability to function. They often tell us, “I feel like a different person for one to two weeks every month.” And they’re not exaggerating. Let’s take a closer look at what PMDD is, why it matters, and how we can better support those who live with it. What Is PMDD? Premenstrual Dysphoric Disorder (PMDD) is a hormone-related mood disorder that occurs in the luteal phase of the menstrual cycle, typically the 1–2 weeks before menstruation begins. While many people experience some level of premenstrual symptoms, PMDD goes beyond discomfort. It’s disruptive, severe, and cyclical. Symptoms may include: Severe mood swings Depressed mood or feelings of hopelessness Intense irritability or anger Marked anxiety or tension Difficulty concentrating Fatigue or low energy Sleep disturbances Appetite changes or food cravings Physical symptoms like bloating, breast tenderness, or joint pain To meet the clinical criteria for PMDD, these symptoms must appear during most cycles over the course of a year, cause significant impairment, and resolve shortly after menstruation starts. Why It Matters Too often, PMDD is missed, minimized, or misdiagnosed. It’s not uncommon for women to be told they’re “just emotional,” “overreacting,” or dealing with “normal hormonal stuff.” But PMDD isn’t just about hormones. Let’s say it again louder for the folks in the back: PMDD is not just about hormones. In fact, the hormone levels of people with PMDD are typically the same as those without it. The difference lies in how the brain responds to hormonal shifts, particularly the natural fluctuations in estrogen and progesterone. This heightened sensitivity can have a dramatic impact on a person’s mental health, relationships, and overall quality of life. It’s not unusual for those with PMDD to experience severe mood changes, including suicidal thoughts, during the luteal phase of their cycle. Then, as quickly as those distressing thoughts appear, they often disappear once the cycle ends, leaving many feeling confused, scared, and emotionally unsettled. This isn’t just anecdotal. Research shows that PMDD is associated with a significantly increased risk of suicidal ideation and behavior. In other words, this isn’t something we can afford to brush off. And yet, far too often, we still do. Why It’s Often Missed One of the biggest reasons PMDD remains under the radar is because it requires tracking symptoms over multiple months to diagnose accurately. This takes time, awareness, and in many cases, a provider who knows what to look for. In my practice, we’ve worked with clients who’ve been misdiagnosed with bipolar disorder, generalized anxiety disorder, or major depressive disorder, only to discover that their symptoms had a very specific, recurring pattern tied to their cycle. And that’s the power of proper diagnosis: It can turn confusion into clarity. When someone finally sees their symptoms as part of a predictable, physiological pattern, not a personal failing, it can be incredibly validating and freeing. What Can Help? Fortunately, there are evidence-based treatments that can bring relief. The key is tailoring treatment to the individual and often combining medical and psychological approaches. Here’s what can help: Cycle tracking: Using apps or mood journals to identify patterns and symptom timing. SSRIs: Selective serotonin reuptake inhibitors (like fluoxetine or sertraline) have been shown to be effective when taken daily or just during the luteal phase. Hormonal birth control: For some, these can stabilize hormone fluctuations, though results vary. Lifestyle changes: Regular exercise, reduced caffeine and alcohol intake, and adequate sleep can ease symptoms. Cognitive Behavioral Therapy (CBT): This is a particularly powerful tool. CBT can help clients identify automatic thoughts, reduce shame, and build emotion regulation skills that offer support even when symptoms flare. Moving the Conversation Forward It’s time we start giving PMDD the attention it deserves. Women and people who menstruate deserve to have their experiences taken seriously, and not just in private therapy offices, but in public health conversations and clinical training programs. PMDD is real. It’s treatable. And for many, naming it is the first step toward healing. If you or someone you love struggles with intense mood changes before their period, don’t write it off. Track it. Talk about it. And reach out for help. You deserve support. Chamin Ajjan, MS, LCSW, ACT - Blog

When focusing on feelings can go overboard and add more stress. Key points Respecting and validating feelings is critical when it come to helping kids with separation anxiety. But more is not always better, especially for deeply feeling kids who can stuck and ruminate. Talking about feelings all the time can increase distress and anxiety What they need is validation and also help moving on, not looping alongside them. A crying young girl holding an adult’s hand In this day and age of "gentle parenting," moms and dads have gotten the message that when it comes to respecting and helping kids manage their feelings, more is always better. But in practice, what I am finding is that this approach is not what's most helpful to kids, that it's not leading to working through their feelings and reducing anxiety, it's getting them stuck in their feelings and increasing distress and anxiety. A recent case provides a powerful illustration of this phenomenon, that reflects what many other families are experiencing. It provides a roadmap for how to thread the needle of showing respect and validation for feelings, while also helping kids work through them. A mom and dad sought my consultation because they were concerned about the intense anxiety their five-year-old daughter was experiencing when separated from them. She is a deeply feeling child who can stuck when she has a big worry or is feeling sad. She ruminates and has a hard time paying attention to anything else. These parents had divorced when their child was two-and-a-half. Their separation was amicable. They get along well and coparent collaboratively. Even so, their daughter has struggled with deep feelings of sadness about missing them when she can’t be with them. It’s most intense at school. Their child generally enjoys school—learning and playing—and when they pick her up at the end of the day, she almost always says it was great. But every morning and evening she ruminates on how much she’s going to miss them when she’s back at school. She talks almost constantly about how sad she is when she’s at school and not with them. It has taken over; it feels like all their time is spent discussing her sadness and brainstorming ways to reduce it, leaving little space for connecting joyfully. Their daughter has been in therapy since she was four. Her parents have done everything her therapist has suggested, which is all in sync with their parenting approach: they ask about, listen to and empathize with her feelings; they help her think of strategies to try when she is missing them sad at school; they share their own feelings of missing her and how they think about her and feel connected with her throughout the day; they have given her trinkets from our workplaces that she can have with her at school. While she seems responsive to these strategies and eager to have these discussions, none of it has reduced her looping and preoccupation. They don’t see any significant change. Also of concern is that their daughter seems to be confusing love with worry. When they tell her that they miss her, too, when they're not together, but that they're also okay, she has responded: “If you’re not worried when you’re not with me, it means you don’t love me.” The Insights It’s to be expected that a child will experience deep sadness and confusion about a parental separation. They need validation of and compassion for their feelings, and lots of opportunities to work through these emotions and to make sense of their experiences. But my strong sense is that, as counterintuitive as it might seem, at this point, it’s too much. What seems loving and sensitive and “right” in theory—processing her feelings for long periods and brainstorming solutions—is actually not what Sasha needs or what will help her work through the separation anxiety. It’s intensifying her rumination—the “looping”—repetitively thinking about the same distressing thoughts without moving toward resolution. It’s keeping her stuck in the feelings in a way that isn’t healthy. When I share this insight, it resonates. Knowing their daughter as they do, they can see that the incessant discussion about her missing them is only exacerbating her distress, not alleviating it. They know living in this constant state of stress is not healthy for her. The Guidance Given this assessment, my guidance to these parents is to: Make a book that tells the story of their family using photos. It starts with the parents meeting, getting married—their life together before they had their daughter. Then her birth, their time together as a family, and their lives now—times they spend together and separately with her. The purpose of this is to recognize and honor their family’s journey—to celebrate their times together while acknowledging all the changes. Make a poster with their daughter that lists her big feelings and the tools she has to cope with them. They take photos of her using the different tools/strategies that she can access when she’s feeling sad or worried. This serves as a visual for ways she can get calm and remind herself that mommy and daddy are always there for her, even though they’re not together in the same house. Clarify for their daughter that when they are apart from her, they think about her and can’t wait to hear all about her day and to be together again, but they are not sad, worried, or suffering. They are doing important grown-up things that they really enjoy and she is doing really important kid things that are helping her mind and body grow. They explain that it was a mistake for them to connect love with worry. You can be separated and feel safe and secure inside. No longer partner in her perseveration; they acknowledge her feelings and then let her feel them. They don’t try to make it all better, apologize, or spend long periods of time brainstorming how she can handle them. Those responses historically resulted in more rumination and stress for their daughter. They remind her of her list of tools that she can refer to and use any time. Then they help her move on by engaging in a fun activity. The Outcome They followed my advice and changed their approach. Instead of going down rabbit holes trying to help her manage her emotions, they respond empathetically but more dispassionately and tell her we trust her to be okay at school. They made the photo album telling the story of their family and also talked to her about mistaking worrying for love. The first week, they had some bright moments followed by some hard moments when their daughter turned to school after missing a few days for a trip. Then they saw a shift. She may mention once or twice that she misses the other parent or that she will miss them at school, and then she basically drops it; she doesn't loop. In the last few days, she has started telling them all the reasons school WILL be okay. She'll say things like, ‘I might miss my parents at school, but it's kind of good because that's where I get to spend time with my friends, and I don't do that at home.’ Or, instead of saying she's worried, she'll say, ‘I think I'll be okay today because so and so will be there.’ They now feel that the bulk of their time is spent enjoying each other's company and not managing emotions. They are also finding that the positive impacts are resulting in much less anxiety going to school and back and forth between houses, which had been major stressors for their daughter. Claire Lerner, LCSW-C -blog

What research says about gender differences in compulsive sexual behavior disorder (CSBD). Key points CSBD affects all genders, with a similar core pattern of symptoms. Women face more stigma and have a harder time accessing help or treatment for CSBD. Inclusive, gender-sensitive approaches are key to better support and treatment for CSBD. Man looking out the window This post was written by Ewelina Kowalewska, Ph.D., researcher at the Centre of Postgraduate Medical Education in Warsaw, Poland, and leading expert on women with compulsive sexual behavior disorder. Out-of-control sexual behavior, now officially termed compulsive sexual behavior disorder (CSBD) in the International Classification of Diseases, 11th Revision (ICD-11; World Health Organization, 2022), has long been recognized in clinical and everyday life, yet for much of its history, scientific understanding has focused primarily on men. But does CSBD look and feel the same for everyone, regardless of gender? Meet Jamie: A Story Beyond the Stereotype Jamie is 30 years old. She first encountered pornography at age 11 and gradually moved on to more extreme content, describing herself as addicted and aroused by pain. She now uses pornography daily, sometimes bingeing for whole days or weekends. Although she prefers high-intensity partnered sex at parties, both activities give her similar feelings of arousal and relief. She experiences cycles of being "decent" and self-destructive. Her lack of control over sex and substances intensified after two assault experiences. The consequences include neglecting work, social withdrawal, family conflicts, sex-related injuries, sexually transmitted infections (STIs), and broken relationships. Despite many failed attempts, she feels she cannot stop it. How Common Is It? Jamie’s story highlights that CSBD is about far more than how often someone engages in sexual activity. It’s deeply tied to emotional regulation, the fallout in everyday life, trauma histories, the weight of stigma, and the presence or absence of support systems. This condition can affect women as much as men and gender-diverse individuals, challenging narrow perceptions. A recent large-scale survey across 42 countries found that 2.42 percent of women screen at high risk for CSBD (Bőthe et al., 2023). However, these figures aren’t fixed—they ebb and flow with cultural attitudes and social contexts. This variability reminds us that CSBD is a widespread concern transcending gender and geography. Similar Distress, Different Dynamics Though men and women share key features—a persistent, often distressing failure to control sexual urges leading to negative consequences—the context can differ (Kowalewska et al., 2020; 2024; 2025): Sexual behavior patterns: Men tend to report higher pornography consumption and solitary sexual activity (i.e., masturbation) as problematic, while women more often describe emotional turbulence, relational difficulties, and impulsive or risky partnered sex. Motivations and triggers: Men and women can use sex or pornography as an escape from negative emotions, boredom, or stress, but women report greater levels of shame and internalized stigma, sometimes tied to societal attitudes toward female sexuality. Functional impairment: Importantly, for women who meet CSBD criteria, the degree of distress, disruption to daily life, and comorbid mental health issues (including anxiety, depression, and trauma histories) are just as significant as for men, even if the absolute frequency of behaviors is lower. Help-seeking: Women and gender-diverse individuals encounter more barriers to accessing support, from stigma and lack of specialized resources to misdiagnosis or disbelief from professionals. Key Similarities: Core Mechanisms Despite these differences, recent research (Kowalewska et al., 2020; 2024; 2025) shows important overlaps: Core mechanisms such as impulsivity, emotional dysregulation, and trauma are consistently identified as robust transdiagnostic risk factors for CSBD across all genders; however, the expression and functional role of these mechanisms appear to differ significantly between genders. Though men are more likely to label themselves as “addicted,” women with CSBD experience equivalent levels of distress and functional impairment. Cross-cultural studies suggest the outcomes (social, occupational, or relationship difficulties) are comparable, emphasizing the need for inclusive prevention and treatment strategies. The Need for Gender-Sensitive Approaches When we overlook gender diversity in research and clinical care, we miss crucial diagnoses and leave the needs of women and gender-diverse individuals unmet. To truly help individuals like Jamie—no matter their gender—we need assessment tools that are validated for all, outreach tailored to diverse experiences, and a deeper awareness of the unique barriers people face. Recent advances make it clear: CSBD isn’t just about male sexuality spiraling out of control. It’s a complex, multifaceted condition that demands a nuanced, person-first approach. Only by embracing this complexity can we break down shame and stigma and better support those who live with this condition. Beáta Bőthe, Ph.D., and Mónika Koós, Ph.D. - blog

Self-care, boundaries, and a clear mission will help you care for your parent. Key points You may need to accept that your care receiver will not likely change. Self-care is crucial when caregiving a difficult parent. Periodically revisit your boundaries to see how you are managing. A stressed caregiver sits beside her elderly parent Joanna could have screamed in frustration, but she had promised herself she wouldn’t. Her mother, Barbara, who had progressing vascular dementia, made everything more difficult than it had to be. If Barbara had an opportunity to criticize Joanna or anything she did, she took it and ran with it. She had complaints for every situation. On one occasion, Joanna had prepared a basic lunch of soup and a sandwich, but it was not hot enough, had no flavor, and was too much to eat. Barbara might add that she couldn’t imagine how Joanna fed her family, the poor things. Every time Joanna drove her mother to her many medical appointments, she had to listen to a constant critique: she was driving too fast, stopped too suddenly, and wasn’t paying adequate attention. It didn’t matter that Joanna was a careful driver and had not been in an accident or gotten speeding tickets in decades. But her mother continued to complain. When she started caring for her mother a year earlier, who lived in an apartment two miles away, she knew it would be challenging. Barbara had never been an especially empathic mother. She had always been tough and hard to please. While growing up, Joanna had struggled with feelings of inadequacy and guilt. At age 50, she’d been through plenty of psychotherapy and had raised her own two children with a supportive husband. But the old feelings came back like they happened yesterday. This time, she was triggered by Barbara telling her she looked like she’d gained weight and had bags under her eyes. But Joanna didn’t react. She used the tools she’d learned and practiced to maintain calm and keep herself in the moment. She reminded herself that her mother was unhappy and was trying to take it out on her. Joanna wouldn’t accept the bait. If you are caring for a difficult family member, here are a few pointers that made it easier for Joanna to manage her difficult mother: Radical acceptance. Accept that your care receiver will not likely change. This is who she is, and that reflects on her, not on you. If she must criticize, you should anticipate it, see it as her externalizing of her pain, and let it go. She probably doesn’t see you as you are, but projects her disappointment and anger onto you. You define your caregiving mission. You are choosing to provide care because it feels like the right thing to do. You are not doing it to win her gratitude or gain impossible-to-get approval. If you decide to change how much you will continue to care for her, that is a personal decision based on your needs; you have every right to make such a decision. Check in with yourself about how it’s going. Take good care of yourself. Constant criticism and negative emotion will wear you down, even if you have good boundaries. Make sure you take breaks, do things with your family or friends, and find a therapist to talk to if needed. Don’t let the painful feelings build up inside you. You have to work hard to maintain your own sense of well-being. You are worth it. Step back if it feels like too much. Know your boundaries. Bring in others to help you, whether family, friends, neighbors, or hired caregivers. Your mental and physical health are important. Julia L. Mayer, Psy.D., and Barry J. Jacobs, Psy.D. -

A challenge to the assumption that hoarding is purely behavioral or rooted in indecision. Key points A recent study on hoarding points toward an interplay among emotion, perception, and social cognition. The mind’s need for connection, when unmet, may be rerouted toward the tangible, an adaptive strategy. The clutter that fills a hoarder’s home might be read as a neuropsychological footprint of loneliness. In Amanda Uhle’s recent book, Destroy This House (Summit Books, 2025), Uhle describes an interaction between her hoarder mother and nonhoarder father: “It was weird how Dad never complained about Mom’s endless and towering piles of stuff everywhere, while my bike on the lawn was a nagging, burning annoyance. I’d learned that Dad seemed not to see Mom’s messes, or any of her flaws. She returned the favor, and for each other, they were blameless.” Women observing an unorganized room Hoarding Disorder and Relationships In neuropsychology, the most fascinating disorders often blur the line between the mind and the social world, showing how relationships, perception, and emotion are tightly bound to the brain’s circuitry. Hoarding disorder is one of these. People who hoard are often portrayed as eccentric or overwhelmed by clutter, but research is increasingly showing that the issue runs much deeper. It’s not just about collecting objects; it’s about how those objects come to fill an emotional and social void. A recent study by Victoria Edwards, Paul Salkovskis, and Victoria Bream, titled “Do they really care? Specificity of social support issues in hoarding disorder and obsessive-compulsive disorder” (2023), explores this psychological and neurobiological terrain by asking a simple but revealing question: How do people with hoarding disorder perceive social support compared to those with obsessive-compulsive disorder (OCD) or no psychiatric condition at all? At first glance, hoarding disorder and OCD might seem like close cousins. Both involve intrusive thoughts and repetitive behaviors. Both show patterns of cognitive rigidity and anxiety-driven rituals that are mirrored in the brain’s cortico-striatal-thalamic loop circuit. That same loop helps govern habit formation and inhibition. Yet Edwards and her colleagues found that when you look at how individuals experience relationships, the two disorders diverge dramatically. The researchers hypothesized that people who hoard may not simply be disorganized or sentimentally attached to their belongings. They may, at a deeper psychological level, be compensating for a deficit in social connection. When humans don’t feel emotionally supported by other humans, their brains may seek stability elsewhere, in objects, routines, or material surrogates for affection. The Study The study recruited individuals diagnosed with hoarding disorder, individuals with OCD, and a control group without psychiatric conditions. Each participant was evaluated through structured interviews and a set of questionnaires designed to measure the size of their social network, their perception of how much support they receive, their levels of loneliness, and their sense of belonging. What emerged from the data was striking. People with hoarding disorder did not just have smaller social networks than healthy controls; they also felt less supported by the people in their lives. This distinction between objective and perceived social support is crucial. It suggests that the neural and cognitive systems involved in appraising social feedback, those that help us interpret emotional signals, empathy, and trust, may function differently in individuals who hoard. In neuropsychological terms, this could point to differences in regions such as the anterior cingulate cortex, the insula, and the medial prefrontal cortex—areas deeply implicated in social pain, emotional regulation, and self-referential thought. When these regions underperform or miscommunicate with the limbic system (which controls basic emotions such as fear, pleasure, and anger, as well as the drives for food, sex, and care of offspring), the result can be a heightened sense of isolation, even in the presence of others. The study found that participants with hoarding disorder reported significantly higher levels of loneliness and thwarted belonging than both the OCD and control groups. Interestingly, individuals with OCD did not show this same pattern, even though their social networks were also smaller. The difference lay in perception, not just behavior. People with OCD might struggle with anxiety and compulsions, but they did not report feeling as profoundly unsupported as those with hoarding tendencies did. The absence of differences in supposed criticism or trauma history across the groups adds another layer of nuance. It suggests that the social deficits in hoarding disorders aren’t merely the result of negative interpersonal experiences or past emotional harm. Instead, they may arise from how the brain encodes and interprets social relationships—a kind of misalignment between external reality and internal representation. Neuropsychologically, this aligns with evidence showing that hoarding disorder involves abnormal activity in the orbitofrontal cortex and anterior cingulate cortex, both of which are involved in evaluating the emotional significance of stimuli. If one’s brain is wired to overvalue possessions but undervalue social cues, it becomes easy to see how objects might come to feel safer, more reliable, and less judgmental than people. From a cognitive perspective, the study challenges the assumption that hoarding is purely behavioral or rooted in indecision. Instead, it points toward a more profound interplay between emotion, perception, and social cognition. The mind’s need for connection, when unmet, may be rerouted toward the tangible, an adaptive strategy gone awry. The clutter that fills a hoarder’s home, then, might be read as a neuropsychological footprint of loneliness: a visible manifestation of an invisible social deficit. This idea fits within broader theories of the “social brain,” which propose that humans are neurologically driven to maintain bonds with others. When that drive is thwarted, the same systems that motivate attachment can attach instead to the inanimate. Clinically, this insight has powerful implications. Traditional hoarding treatments have often focused on cognitive-behavioral strategies to reduce clutter or challenge beliefs about possessions. While useful, they may miss a key ingredient, the restoration of social connection. If someone feels fundamentally unsupported or excluded, asking them to discard objects that represent comfort and continuity can feel like emotional annihilation. Therapeutic approaches that rebuild a sense of belonging, whether through group therapy, social skills training, or community engagement, might therefore be essential. Neurobiologically, fostering positive social interaction could modulate the same brain circuits involved in reward, attachment, and emotional regulation, gradually rewiring the patterns that sustain hoarding behavior. Limitations of the Study Edwards and her colleagues are careful to note the limitations of their study. Because it was cross-sectional, they cannot determine whether low perceived support causes hoarding or whether hoarding behavior erodes social networks over time. The sample sizes were small, and all data were self-reported, which could introduce bias. Still, the study’s implications are clear: The social brain plays a central role in understanding why people hoard and how they might recover. Conclusion Ultimately, the study’s question, “Do they really care?” captures both the psychological and neurobiological essence of hoarding disorder. It is a question not only about others but also about the self’s ability to register care, trust it, and reciprocate it. In that sense, hoarding may represent a misfiring of one of the brain’s oldest imperatives: to seek safety in connection. Where human bonds fail, the brain improvises, clinging to the objects that never leave. Shirley M. Mueller, M.D.- blog