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The key to navigating the rollercoaster of teen years is knowing how to hold on. Key points Teens pose a different challenge than younger children. Your challenge is learning how to adapt to their needs. The keys are not confusing ends and means, rewarding the positive, setting clear goals and bottom lines. Think of yourself as a consultant rather than an authoritarian. Help them to explore but with boundaries. Teens can be difficult—sullen, argumentative, impulsive, hormonal—and their prefrontal lobes (the rational brain) are not fully developed. Everyday life can be an emotional roller coaster that many parents barely manage to hang on to. Unlike the 5-year-old that you can pick up and put in their room, the 6-foot, 200-pound teen who refuses to move is immobile. And while the biggest dangers with 5-year-olds are likely to be crossing the street, now the risks are higher—car wrecks, addiction, pregnancy, violence—enough to keep you as parents awake at 3 am. Here are 11 tips for you and your teen to successfully navigate these challenging years: Mom and daughters taking a picture together. 1. Pick your battles Teens, because they are differentiating—pulling away to define who they are—are understandably sensitive to parental control. It’s easy for them to feel micromanaged, over-lectured, and over-advised. Because the over-controlled child will either become dependent and fearful or rebellious, your challenge is not to abdicate your power but shift from being the autocrat to a consultant. To do this effectively, be selective and clear. Decide on your bottom lines —what you’re willing to go to the mat for: one or two things, not twenty. For many parents, their bottom lines center on health and safety. But most importantly, it’s time to stop coaching or criticizing them about what they wear to school; it’s okay to set expectations about staying up to date on schoolwork or about calling if they're running late. 2. Don’t confuse means and ends You think it would be good for your teen to be involved in a school sport or try out for a school play. Great, but what they hear, and feel is pressure to do what you think they should do. Rather than getting into a battle over sports or not, ask yourself, “If doing sports is the means, what is the end, the goal, the purpose—be less isolated, get into better physical shape? Be clear about the end and then be willing to negotiate with them about other ways to get there. 3. Help them do what they can’t Stepping back, what are the one or two things your teen struggles with most? Think macro, not micro: Quitting when they get frustrated or holding on too long; being too self-critical, too risk-averse, too self-centered; unable to regulate their emotions, or too shy to ask for help? Get your concerns on the table, try to gain buy-in, and develop a plan together to help build those skills. 4. Talk in terms of worry and concern rather than frustration or anger People respond better when you use “soft” emotions rather than “hard” ones. This is in the same skill set as using I-statements rather than you-statements. Not only will the conversation go better, but you’re helping your teen learn about you – what goes on in your head as a parent, what is driving what you’re saying and doing. They get to see you not only as “the parent” but as a concerned fellow human being who cares about them. 5. Reward good thinking Many teens are like lousy lawyers: They try to make a case for what they want, but it doesn’t really make sense. But when they do a good job and show clear thinking, reward this thinking by going along with it or at least reaching a middle ground. 6. Be emotional around the positive; be matter of fact about the negative This is a basic mantra for any parenting. Remember that you are essentially your child’s favorite toy. When your child or teen does something positive, get out the confetti and balloons. If they do something negative, drop the emotion and talk about the consequences in a deadpan way. Don’t train your child to seek negative attention. 7. Circle back and repair You make what you think is a neutral comment, and your teen overreacts or rolls their eyes. Mop up then or later but mop up: I’m sorry —I didn’t mean to hurt your feelings or upset you. Why did you get upset? This is about repair and not having misunderstandings become fuel for future explosions. It's about learning the moral of the story of what just happened. 8. Create quality time Gone are the days when your 8-year-old couldn’t wait to hang out with you all day long, but that doesn’t mean they don’t want your company and attention. The key is to be proactive and build in choice: “I was thinking that maybe we could do something together this weekend. Think about it; we can do whatever you’d like. Let me know.” And then remind them on Friday and do whatever they suggest. It’s not about the activity; it’s about having a shared experience. 9. Allow surrogates to step in Your teen may resist your advice, but they may better hear the same advice from a grandparent, an aunt, their best friend’s mother, or a counselor at school. Stand aside, let them do their magic. 10. Judge how they’re doing by looking at the big picture As a parent, it’s easy to get worked up and worried about the small things—the English assignment they’ve been putting off, the latest boyfriend they’re hanging with. To help you not go crazy, step back from these details and drama and instead take stock of how they’re doing overall: Do they have good, relatively wholesome friends? Are they able, overall, to be responsible, manage their emotions, challenge themselves, and envision a positive future? Can they bounce back after an upset? Can they ask for help? Look at the big picture of how well they are running their lives. 11. Seek help And if they are struggling in some way, don’t sweep it under the rug, or cross your fingers and hope they’ll outgrow it. Be proactive: Get advice from someone you trust or an outside professional, or, better yet, put your concerns on the table. Again, don’t confuse means and ends, but help them move forward and learn how to successfully run their lives. Bob Taibbi, L.C.S.W. -Blog

10 tools for handling the next best steps after a mental health diagnosis Key points Receiving a mental health diagnosis often comes with a multitude of feelings and responses. Allowing time to pause, having patience, and asking for support can help. A diagnosis can be the start of traveling the roads of life more effectively. Most mental health providers utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a reference for classifying and coding symptoms. This manual is updated at regular intervals (the most recent version being the DSM-5-TR) in an attempt to provide a standardized way to diagnose mental health conditions and establish a common language. Woman having counseling session Diagnoses can assist in increasing understanding; they are not designed to be critical, limiting, or over-pathologizing. Diagnostic criteria are ever-evolving, often imperfect, and sometimes controversial, but the advantages of having a diagnosis can range from getting insurance coverage for treatment to allowing the formalization of accommodations in various settings. Receiving a mental health diagnosis for yourself or someone you care about can bring on a flood of emotions. Depending on the situation, feelings may include shock, relief, confirmation, confusion, disbelief, and even anger. It is normal to notice a variety of reactions, especially at first; hopefully, however, there can also eventually be a readiness for figuring out the next best steps. Here are 10 steps for better coping that utilize a series of road and driving metaphors: Pausing in the Breakdown Lane Just as when someone pulls over into the breakdown lane to check on an engine light or attend to a crying baby, getting a new diagnosis might require pulling over into the breakdown lane to allow for some moments to reorient. It can be like an emotional flat tire that needs attention. The sudden need to integrate new information and recenter around new routines may not be convenient or planned, but different actions might be needed nonetheless. Pausing, crying, and taking a breath before getting back on the road is absolutely valid and legitimate. Eyes Adjusting to the Dark When we are in the dark trying to find our keys or locate a door handle, we might be disoriented and confused at first. But then, slowly, we begin to see shapes and outlines again. Our eyes and brains need some time to adjust to the dark. Receiving a mental health diagnosis, especially if it's unexpected, can feel like the lights have been turned off temporarily. Allowing ourselves some adjustment and acceptance time is crucial. Visual acuity will return, though new lenses may be needed to adequately perceive different hues and to effectively navigate through new thoroughfares. Studying the Map A new diagnosis provides some overview of the roadways, entrances, and exits. We might need to better understand where the bridges, detours, or road closures are at this current point on our “map.” Learning about our own mental health diagnosis in a curious, compassionate way can provide us with an avenue for more growth and learning. The more we know, the more we grow. And while social media influencers and TikTok videos might help us feel less alone in the journey, maintaining a critical consumer attitude is highly recommended. Finding reliable, science-based information is important. Getting Navigational Guidance Mental health conditions, from ADHD to Zoophobia (fear of non-human animals), are better managed with guidance, especially in the beginning. Mental health providers can provide information about best paths and ideal itineraries given one’s specific situation. Clinicians can help suggest alternative routes or additional tools that might be needed to travel more effectively along the roads. Knowledge is power and gaining new understanding on how to proceed more effectively can be instrumental. Finding Our Lane We all belong on the road, no matter what particular challenges or setbacks might periodically occur. We shouldn’t all be driving in the fast lane; we need to find our own right paths. There may have been confusion in the past about why others seem to have been able to pass along different roads so easily, but awareness of patterns can assist in honoring our needs. Different is not bad, and diagnoses don’t need to be damaging dead ends. Trusting the Engine at Its Core A diagnosis is not a synopsis of who we are. It can be information that might hopefully provide some insight about what is going on, where to possibly remediate, and how to accommodate. The goal is not assimilation. Just as car engines might vary in style, size, and technological advancement, they are still all built to help a car mobilize. Humans are still humans, no matter what set of emotional or behavioral patterns is present. And all humans deserve respect and support in their journey through life. Consider Displaying Those Bumper Stickers Unlike getting a new medical diagnosis, a mental health diagnosis sometimes has more mystery, stigma, or misunderstanding surrounding it. Individuals are sometimes more hesitant to speak with family and friends about this than they might be about a medical issue, but sharing more openly can often be helpful. Telling trusted friends or family members what is going on for you can help them better support you. Using the Horn as Needed We may highly value independence and solo coping, but asking for assistance is a strength. No one can read our minds or automatically know when we need more support, so asking clearly and directly is imperative. And even though proactive or preventative “tapping lightly on the horn” would be ideal, using full-force “horn-beeping” in times of crisis or overwhelm is warranted as well. Using Rest Stops Working on recovery steps with a mental health condition takes work and can work, but individuals also need rest and times of simply engaging in regular life activities. Supporting time to rest and reset, separate from active therapeutic intervention, is invaluable. We need time to focus on what is strong and not just on what feels wrong. Honoring the Unknown We may not know what is around the bend, whether a rainstorm might impact our speed, or if a traffic jam may befall us. But we can keep going despite the unknown. It’s impossible to prepare for all the possible bumps and potholes we will encounter in the miles ahead, but we can aim to trust in the fact that we will figure it out. Sandra Wartski, Psy.D. -Blog, Website

Why your children pull away or turn against you and how to rebuild connection. Daniel tells me his wife has turned their children against him, blaming him for the divorce. Maggie tells me that her children refuse to see her, talk to her, or even respond to text messages. Poppy, who is only 12, says she wants nothing to do with her father and is prepared to starve herself until the judge changes the custody arrangement. These situations are all too common in divorce and heartbreaking to witness. The rejected parent feels helpless, anguished, and desperate. The child often feels abandoned, enraged, confused, and overwhelmed. Father and child having a talk Why do children sometimes reject a parent? It’s complicated. Divorce is emotionally overwhelming for children. They may feel caught in loyalty conflicts or blame one parent for the divorce. They may be anxious about the changes, the custody arrangements, or the financial instability, and cling to one parent for security, rejecting the other. The conflict between the parents is the single most damaging aspect of divorce for children. Parents who speak negatively of each other or pull their children into disputes are setting up a situation where kids feel they need to pick sides. The child may feel they need to support the more vulnerable parent or the parent they believe was “wronged.” Sometimes a parent consciously or unconsciously tries to ally with the children, causing the children to reject or refuse contact with a parent. At times, this evolves into “parental alienation.” Sometimes older children reject both parents. Sometimes the rejection of a parent stems from the relationship or attachment with that parent from before the divorce. If a parent was distant emotionally or less present physically, the child will cling to the parent who has felt more secure or stable. Younger children are apt to cling to the parent who has been their primary attachment, as they fear loss and abandonment. Older kids may have a strong sense of morality or judgment, or anger, and are developmentally more likely to assert their control or independence when their lives feel out of their control. The stressors of divorce can contribute to the rejection. Children are stressed by big changes such as selling the family home, moving, going to a new school, living in two homes, or when there is a new parental partner. Divorces that are litigated, or high conflict, impact the children, and they may gravitate toward the parent who seems to need their support, or who seems the safest. The good news is that the rejection often can soften, although this can take time. This happens when the parents end their conflict and find ways to communicate respectfully. The rejected parent stays patient, loving, empathic, calm, and consistent while the child feels safe expressing their emotions. Family therapy can help to rebuild trust. Daniel and Maggie each grieve the rejection by their children and seek advice. We talk about how to keep the door open to their children, without forcing them to come through it. What can the rejected parent do when this happens? You can’t control your child’s feelings, but you can control your own behavior. You may not understand why your child has rejected you, but your anger, defensiveness, guilt trips, or manipulative behavior can cause your child to withdraw even more. Remind yourself that your child is emotional, confused, and stressed, so your role is to be consistently calm, warm, and steady, even when your child rejects you. Keep communication open but non-intrusive. Boundaries may be a sensitive issue if your children have refused all communication. Periodically send gentle texts or cards reminding your child that you love them and are here for them. Keep messages brief and loving but without pressure. Remember that you cannot persuade your children to reconnect. The goal is to demonstrate to them that it will be safe for them should they reach out to you. Your child needs to feel that it is okay to love both parents. If you and your child are in contact, focus on listening, asking open-ended questions about their life. Take some time to reflect on your relationship with your child before the divorce. Were you reliably present and emotionally available? You may feel that you need to apologize for behaviors or absences, or any way that you may have contributed to their pain. Even if you feel that you have no reason to apologize, it is always helpful to express empathy. Never badmouth the other parent, even if you believe that parent is alienating the children. Poppy complained about her parents “trash-talking” each other and felt that rejecting her father would end her mother’s vitriol about her father. (It didn’t.) Work through your own grief and emotions with an experienced therapist. You may consider family therapy and/or reunification therapy (which may be court-ordered). What not to do: These are traps that will almost certainly undermine your efforts to reconnect. All of these make your child feel controlled and/or unsafe. They never work. Don’t argue with your children about “the truth.” This pushes them back into the loyalty bind. This is one of the hardest challenges for rejected parents. Don’t press them to see you or choose sides. Don’t guilt-trip them. They experience this as manipulative. Don’t pull in other family members (e.g., grandparents, etc.) to advocate for you. Don’t give up and don’t give up hope. Giving up will be felt as another abandonment and may even end the chances of reconciling with them. The reconciliation or reconnection may take months or years. The keys are patience and consistency. If your child is open to reconnecting, go slow and keep it safe. Poppy ultimately sought a relationship with her father after she finished high school. She blamed her mother for turning her against her father, and while she remained in contact with her mother, she kept strict boundaries when her mother began to talk about the divorce. Daniel eventually reconnected with his children after he remarried and moved to another state. He describes his relationship with his children as cool and continues to blame his ex-wife for the disruption. He tries to avoid defending himself to his children and notices that “they withdraw when I go down that road.” Maggie reconnected with her daughter when the daughter married and had a baby but has only superficial contact with her son. “My daughter and I had a few sessions of therapy, and that really helped to clear the air. I hope my son will agree to this someday, too. I will always keep that door wide open for him.” Ann Gold Buscho, Ph.D. -Blog, Book

Even if their symptoms look the same, not all depressions are created equal. Key points Depression is not one uniform condition but a signal communicating issues and struggles in one's inner world. Similar depressive symptoms will have different meanings and functions depending on our personality make-up. Therapy that helps you understand depression in the context of your personality can foster change from within. Depression is often spoken of as if it were a single condition, a uniform experience of sadness, fatigue, or lack of motivation. However, if we look beyond these experiences, we will understand that not all depressions are alike. Psychodynamic depression therapy begins with this premise: that depression is not just a symptom to be removed, but a communication from the psyche, a signal, like a fever, that something within us is struggling for expression or repair. Depressed women looking out the window. Depression as a Signal When someone enters therapy describing a pervasive sadness or emptiness, it’s tempting to look for external causes: loss, stress, trauma, politics, or neurochemical imbalance. These factors might, in fact, matter deeply. Yet how we relate to them depends on our own individual psychological structure—our personality—which gives meaning to our emotions. When we talk about “personality,” we do not mean personality “disorders,” but the ways in which we have come to make sense, consciously and unconsciously, of our own past and present experience. Depression therapy must be attuned to the underlying personality structure rather than treating all depressions as the same “condition.” Depression and Personality Types The four personality styles used as examples below—depressive, narcissistic, borderline, and obsessive-compulsive—do not refer to personality disorders. Instead, they are some of the personality styles that can shape, to a greater or lesser degree, how we organize our experience. Depressive Personality For some people, depression lies close to the core of their personality, as they live with a deep, ongoing struggle around worth, love, and loss. For some of them, depression reflects an internal conviction that something essential about them is damaged or unlovable. Disappointments are experienced as confirmation of their inner badness, and they blame themselves for things that are not truly within their control. For others, their suffering centers more on the fear of abandonment. Depression arises from the terror of being alone or losing attachment figures. Love feels necessary for survival, and when connection is threatened, despair floods in. The person may oscillate between clinging to others for reassurance and withdrawing preemptively to avoid being left. Depression becomes a form of protest and mourning for the real, anticipated, or imagined loss of attachment. In depression therapy, the task is to discern which story the depression is telling—whether it speaks of guilt and unworthiness or of fear and abandonment, and to help the person find words for that internal experience. The work is not to silence the symptom, but to translate its meaning into the language of the self. Narcissistic Personality People with a narcissistic personality style tend to be preoccupied with their standing in relation to others, often displaying grandiose fantasies to mask an internal sense of emptiness. When their fragile sense of self and self-worth collapses, perhaps after criticism, failure, or the loss of admiration, they may feel devastated. The world suddenly seems meaningless, and the person themselves, hollow. Depression might be experienced as shame, emptiness, or humiliation rather than sorrow or guilt. This form of depression is not about loss of a loved object but about a collapse in the structure of the self. The depressive state expresses a crisis of identity, as this personality will tend to fluctuate between grandiosity and self-loathing. This depressive crisis might lead the person to either doubling-down of the illusions that shape their personality, or to emotional numbness; both cases represent defensive mechanisms to avoid pain. In depression therapy, understanding the symptoms in the context of this personality organization involves helping the person tolerate vulnerability without disintegrating, to experience disappointment and limitation without falling into despair. The therapist’s task is to provide a steady, reality-based empathy that can withstand the fluctuations between grandiosity and self-loathing, allowing a more stable and authentic self to emerge. Borderline Personality For people with borderline types of personality organization, typically marked by volatile and unstable relationships with self and others, depression often carries the intensity of relational trauma. Feelings shift rapidly from despair to rage, from fear of abandonment to numbness. The depressive experience is often entwined with the terror of losing connection, of being left or rejected. The person may experience their emotions as overwhelming and uncontainable, oscillating between clinging to others for survival and pushing them away to avoid anticipated rejection. Depression in this context signals an unbearable sense of aloneness, often rooted in early experiences when attachment figures were inconsistent or emotionally unavailable. In therapy, the work involves creating a relationship stable enough to bear the turbulence. Depression therapy becomes less about symptom reduction and more about helping the person develop a capacity to recognize and regulate emotion, to see their moods as part of an ongoing inner dialogue. Over time, the depressive states become less catastrophic and more thinkable, an internal weather that can be survived rather than annihilating. Obsessive-Compulsive Personality For those with an obsessive-compulsive personality, who strive to maintain order, mastery, and control to avoid the anxiety that uncertainty and unpredictability creates, depression often manifests through overcontrol, rumination, and self-reproach. When they fail to meet their own strict and demanding standards, depression sets in as a kind of punishment, a moral or logical consequence of imperfection in a context in which chaos or guilt can feel overwhelming. Here, depression serves as a custodian for an inner world governed by harsh demands and expectations. The mind, striving to stay in control, suppresses spontaneity and emotion, leading to a sense of lifelessness. The person may not describe sadness so much as emptiness or exhaustion, the fatigue of sustaining an internal dictatorship. In depression therapy, progress comes from loosening these rigid internal rules. The therapist helps the individual develop a more compassionate inner dialogue, allowing the emergence of feeling, play, and desire without catastrophic guilt. Depression lifts not because the person gains control, but because they can tolerate losing it. How Depression Therapy Helps Across these personality syndromes, depression is not random or a collection of emotional symptoms. It speaks the language of the personality that carries it, one that can be listened to in therapy. The depressed person’s suffering is, deep inside, an expression of their underlying conflict between love and aggression, connection and autonomy, idealization and reality. What looks like the same symptom—a withdrawal of energy, loss of interest, or self-blame—has profoundly different meanings depending on its psychic context. As a result, working with depression in therapy requires us to understand our characteristic emotional world. When we trace the threads of depression back to the structure of the self, we begin to see that it is not an intruder but a messenger. When we listen to depression as communication, we can begin to hear the unconscious story it is trying to tell. Santiago Delboy, MBA, LCSW. -Blog, Website

Identity and world confusion stem from trauma and dissociation. Judith Herman observed that "the conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma" (Herman, 1992). This tension manifests in how many trauma survivors inhabit a kind of psychological superposition—simultaneously experiencing the life they have and the lives they might have had, in worlds and lives half-real, and half-imagined. Hand reaching toward sunlight in a forest. The will to proclaim These alternate universes aren't idle speculation. They're vivid, persistent mental realities that shape self-understanding and recovery, reflecting both the proclamation of loss and the denial of pain. Existing in dissociative spaces of the might-have-been, in fantasy and conflict with real life, in dreams which sometimes feel more real than waking life, running in the background to have real hidden impact. (The quantum mechanics language is purely metaphorical here—this describes subjective experience, not physics.) Consider the person who experiences significant loss in childhood. The self that emerged from that event develops along one trajectory, while an imagined alternate self—the one who never faced that loss—remains a haunting presence. It feels a bit like we imagine the "many worlds interpretation" of quantum mechanics, the what-ifs of infinite possibility. This can be more overt—who might I have been if my mother hadn't become ill with cancer, and died young, when I was a child? Or more subtle—what if one's parents had been more competent and resourced, focused on the child's developmental needs, enabling one to choose a career more out of passion, rather than pure necessity? Sometimes these lives re-emerge later on in development; sometimes we carry them, unlived, to the grave. Somewhere in the space between these selves lies the work of integration: a reconciliation not just of loss, but of identity itself. Thinking the unknowable: The better universe Counterfactual thinking—persistent "if only" and "what if" thoughts—is nearly universal, but for many survivors of severe trauma and loss, the intensity is next-level. Research suggests that these thoughts are associated with increased PTSD symptoms and emotional distress, particularly when they highlight the gap between one's actual self and an idealized alternate self (Brancu et al., 2016; Caramanica et al., 2018). Emotional numbing can be pervasive and associated with emotional dysregulation and loss of a coherent sense of self, tantamount to a fracturing of the personality known as "structural dissociation" (Steele, van der Hart & Nijenhuis, 2005). The simplest is primary structural dissociation, where one is divided into a world-facing "apparently normal part" of the person (ANP) and an "emotional part" (EP). More severe levels are fragmentation into many EPs but one ANP, and then many ANPs and EPs (paralleling dissociative identity disorder). Some of these selves, the EPs, hold the might-have-beens, the fantasies and anguish of lost lives which, to them, can only be imagined. Phobias, within this model, ward off integration into a fuller personality. These alternate selves become a language for grief. In the better universe, survivors imagine themselves unburdened by hypervigilance, undistorted by defensive adaptations, with access to relationships and opportunities that trauma foreclosed. This imagined self transcends fantasy—it represents honest mourning for a blind developmental path. There is recognition of how unfortunate events actually must have changed what could have been, which nevertheless may be experienced as tormentingly out of reach... unlike the alternative universes which, in some science fiction narratives, are accessible—though at the expense of displacing the me who is already there. The better universe extends beyond individual identity into relational life. Survivors imagine how they might parent differently, love more freely, trust more easily, who they might have met or married, the ones who got away because of residual problems, or the ones we stayed with who we otherwise might have left. Early parental loss, for instance, profoundly shapes adult attachment patterns, emotional regulation, and capacity for intimacy (Høeg et al., 2018). From a psychoanalytic perspective, fantasies of perfection can both motivate and paralyze (Rothstein, 1984; Colombi, 2017). When survivors strive relentlessly toward an idealized self, attempting to "undo" the past through achievement or flawless relationships, they may unwittingly reinforce the notion that their present, imperfect self is unacceptable. The better universe may become a prison of impossible standards. The Worser Universe The opposite comparison is equally important: the universe where things went worse. "Others have it worse than me." "At least I wasn't..." "Real trauma is what happens to combat veterans, refugees, or abuse survivors." This is the other extreme—the will to deny. This defensive comparison serves multiple functions. It minimizes psychic pain, protecting against fully experiencing it. It lets us move on, near-mortally wounded. Most insidiously, it disqualifies one's experience before anyone else can. Contemporary stoicism—valuable in its original philosophical form—may be misappropriated for this purpose. What begins as wisdom about focusing on what one can control becomes a weapon against legitimate suffering. The hierarchy of trauma is pervasive and damaging. My trauma isn't "good enough," itself often a post-traumatic reaction. Chronic illness, emotional neglect, persistent bullying, medical trauma—don't seem "bad enough" to count. The worse universe they imagine validates this dismissal: Someone else always had it harder, so their pain doesn't count, or is just an unlucky roll of the dice. This comparison is as much a barrier to healing as idealizing the better universe. Both prevent inhabiting the universe within which we are, where we can have real impact. The Before and After Problem The integration work differs depending on trauma type, following the chasm created by overwhelming trauma. Discrete trauma may require integrating two (or more) distinct selves across a visible divide—the me who was born biologically, and the me born as an adaptation. Complex trauma demands making sense of a self that developed within adversity, starting with restoring safe attachment, a "relational home" (Dorahy & van der Hart, 2015), where there may be no clear "before" to remember or idealize (Herman, 1992; van der Kolk, 2014) for those with disruptions of autobiographical memory and narrative. We need a "good enough reality" (Brenner, 2025)—not a perfect one. Either way, the developmental reality remains: We become ourselves through these experiences, not in spite of them. We "come to terms" and "fake it until we make it." The adaptations that once ensured survival—hypervigilance, emotional constriction, perfectionism, self-doubt—dissolve into the fabric of identity, integrated and not rejected or abandoned. They're not foreign objects to be extracted but aspects of self to be understood, honored for their protective function, and amends to be made with gratitude for services rendered. The ordinary world Neither the better universe nor the worse universe is where we actually live. Healing isn't about choosing which alternate timeline is "true" or denying impact. It's about making the most of the developmental paths actually open to us, and expanding those possibilities as we move forward, looking back to learn from rather than be fixated on the past. Self-compassion is essential here. Research consistently demonstrates that compassion strengthens resilience and rewires the brain, helping survivors regulate emotions, reduce PTSD symptoms, and develop adaptive coping strategies (Neff & Germer, 2013; Hoffart et al., 2015; Friis et al., 2016). The practice of compassion alters brain networks, updating our operating system when it comes to the kinds of relationships we can have with ourselves (e.g., Kelly & Huffman, 2025) while enabling us to see better futures and move toward them as good stewards for ourselves. The alternate universes may always whisper in the background, and that can, in time, turn into a more rewarding than tormenting experience. Healing happens in the present moment, over and over, one at a time—the only place where choice exists, where one can read while writing the next chapter rather than endlessly revising earlier ones. Grant Hilary Brenner, M.D. -Blog

Whether you stay or go, it's vital to change how you interact with a narcissist. Key points Specific traits must be present for someone to be diagnosed with narcissistic personality disorder. The term "narcissist" is now frequently overused; not all jerks are narcissists. If you love someone with these traits, it's vital to learn to avoid destructive emotional interactions. Two people having a serious conversation over coffee in a cozy café. Narcissism. That word gets thrown around a good deal these days to describe someone who’s self-absorbed, grandiose, or abrasive. These may be annoying personality traits, but standing alone, they don't reflect narcissism. So, what is a true narcissist? A narcissist displays a terribly inflated ego or sense of importance and seems to believe the world should revolve around him; he can be impatient, critical, and lacking in empathy. He blames you for problems despite your repeated attempts to prove otherwise, and can accuse you of maliciously plotting against him. He may frequently threaten to cut you off, and might even follow through at some point. And perhaps the worst—he makes you question your very sanity or logic, tending instead to undermine the way you see or remember things. It's called "gaslighting," and narcissists do it on a regular basis as a means of control. When these dynamics are part of someone's relationships with almost everyone their life touches, it's termed narcissistic personality disorder. Yet just because someone is a selfish jerk doesn’t mean he's a narcissist. Someone can easily struggle with narcissistic traits, like grandiosity or a tendency toward self-focus. So, what can you do if you love someone with narcissistic traits? 1. Don't get stuck arguing about how you're a good person. You aren't going to win any battle with him; he'll rarely, if ever, allow that. The answer is to disengage from the emotionally volatile battles that might be raging between the two of you. You won't win. 2. Confront the demeaning treatment you've absorbed and set a boundary. Challenge the validity of the abusive labels he has called you, not to him directly, but within yourself. You may have internalized far more than you realized. If you're depressed, seek professional help. You can learn how to structure your communication with him, so if and when he becomes abusive, you can set a boundary that you're not going to accept his bad behavior. You can decide your own limits of what you'll be around for—and what you simply will not. Going into therapy is sometimes vital for this step, as you can learn how to stop emotionally responding. Instead, you can respond with logic and clarity. 3. Take responsibility for being attracted to your partner's initial charm. The over-the-top attention you first received somehow swept you up. You didn't view it as possessiveness or see the warning signs that were more than likely there. Maybe that was due to your own shaky sense of worth, or maybe because you were tired of being alone. If you recognize you're part of the dynamic, it's more probable you'll be able to detach from what keeps you stuck. 4. Realize how your strengths are manipulated. Often, a narcissist will seek out partners who pride themselves on taking responsibility, who are conscientious, and who will work hard to please. They seek those who love so deeply that they will deny how abusive things are. They will manipulate that and use it against you—if you allow it. 5. Decide that you can tolerate that your partner will initially blame you. You have to learn to not accept the blame and calmly step out of their attempts to do so. If you stay or if you go... Work on these five commitments so that you can begin the process of believing in yourself, valuing who you are and what you stand for. If you stay in the relationship, detaching with logic and reason is the answer—avoiding and simply not participating in long, drawn-out emotional battles. He may not like it, but with enough practice, he'll hopefully respond. If you leave, things will likely also get worse for a while. His rage at being called on the carpet can boil over and become ugly. Don’t allow yourself to be drawn into the battles; you won’t convince him of anything. If there are children involved, it's particularly painful. You're likely to watch them realize what the narcissistic parent is unwilling, if not incapable, of providing. And that can be very difficult to watch. It's highly likely that if you attempt to intervene in their relationship, it will only escalate your past partner’s behavior. The best you can do is to provide steady and consistent support for your child. It's hard loving a narcissist. It's important to remember that he's miserable underneath his entitlement; yet it doesn't mean you have to be miserable along with him. Margaret Rutherford, Ph.D. -Blog

The aftermath of a parental suicide increases the child's risk of suicide. Key points Children internalize feelings of shame or self-blame in the wake of a parent who chose to die by suicide. Children who have lost a parent to suicide are three times more likely to die by suicide. This association may not only be because of trauma, but by hereditary and environmental factors. A young person sitting thoughtfully and talking with a therapist According to the World Health Organization, more than 720,000 people die by suicide each year, and it remains the third leading cause of death for 15- to 29-year-olds. Many children are left to grieve the loss of a parent to suicide, a painful experience that often leads to mental health struggles such as depression, anxiety, and even thoughts of suicide themselves. There is a 3.8 percent lifetime prevalence of suicide exposure within a family, which means that about 1 in 25 people will be directly affected by this tragedy. There are many adverse outcomes of dealing with parental suicide for children, including psychological issues such as post-traumatic stress disorder and substance use, social challenges around building healthy relationships or fears of intimacy, and even physical health concerns like cardiovascular disease. Madelon Sprengnether, regents professor emerita at the University of Minnesota, reflects on her own experience grappling with the loss of her stepfather to what she believes was an intentional overdose. She recalls, “My feelings in the immediate aftermath of my stepfather’s death were a mix of horror, guilt, shame, and something like numbness.” Guilt is a common response when suicide occurs within a family. A study by Clémence Ceruzé and colleagues emphasizes how these feelings of guilt can complicate social connections. Children often internalize their emotions and develop feelings of shame or self-blame in an attempt to understand why a parent might choose to die by suicide. Sprengnether’s struggles reflect the findings in Ceruzé’s research on the impact of suicide on social relationships: “My understanding now of what happened to me in the aftermath of my stepfather’s death is that I shut down emotionally. My natural shyness deepened, which made it hard for me to make friends in college, much less to find a boyfriend—both typical experiences for girls of my age.” Alarmingly, research shows a significant increase in the risk of suicide and suicide attempts among the children of parents who have died by suicide. Specifically, children who have lost a parent to suicide are three times more likely to die by suicide and twice as likely to attempt suicide than children with two living parents. Psychotherapist Colleen Mousseau serves as the clinical director of a therapy practice that supports grieving youth dealing with the loss of loved ones. Having worked with many child survivors of parental suicide, Mousseau understands the common occurrence of suicidal ideation among these bereaved youth and how this experience is relatively different from the grief associated with other causes of parental death. “Many other causes of death can be explained in a way that quickly resolves feelings of guilt and responsibility. When someone dies by suicide, it can be difficult for those who are grieving to know where to place the blame. There can be deep feelings of betrayal, abandonment, and confusion that are difficult to resolve after a suicide.” Several key factors may contribute to the higher prevalence of self-injurious behaviors among youth who have been previously exposed to suicide. Genetic factors like impulsive aggression and neuroticism can predispose a child to suicidal behaviors, as well as environmental influences before and after a parent's suicide, such as neglect, abuse, and family adversity. Imitation of a caregiver’s actions as a coping mechanism can also be a risk factor for suicide. Finally, the trauma of a parent’s suicide is enough to increase the likelihood of self-harm. To help bereaved children, Mousseau suggests a safe and supportive space to understand, gain information, express feelings, and provide opportunities for connection with the person who passed away. Group-based support can especially help mitigate the isolation and loneliness associated with grieving parental suicide. It is crucial to avoid placing blame on the family or child. It’s also important to use age-appropriate language and work with the surviving parent or other bereaved family members to encourage open, honest conversations and promote healing. This approach can be key in helping a child navigate their grief. The need for effective therapy treatments, evidence-based programs, and family support interventions continues. A 2023 study explored a therapy program aimed at improving parenting practices known as the family bereavement program, which effectively reduced suicide risk among parentally bereaved children 6 to 15 years after the intervention. In the aftermath of the tragic reality of suicide, loved ones are left to grapple with a range of intensely painful emotions. For children, especially, this can be confusing and even more devastating. However, healing is possible, and though the journey might look different for each individual, it often begins with having the right support. Fostering understanding and connection, rather than shame or isolation, is crucial in helping children cope with parental suicide. Robert T. Muller, Ph.D. -Blog, Link

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