Growing research shows the gap between perception and reality for narcissistic people goes far deeper than their inflated views about their appearance, accomplishments and abilities.

Narcissism is a personality trait that exists along a spectrum, where the lower end reflects a healthy balance of self-esteem and confidence. At the extreme end of the spectrum, however, narcissism is considered a personality disorder which affects 1-2% of the population. Most of us manifest narcissistic traits to varying degrees, but the more elevated the features are, the wider the gap between perception and reality.

Narcissistic people with elevated features frequently belittle anyone who fails to provide them with the special treatment they feel entitled to. Ironically, they continuously undermine the false self they are trying to build and maintain.

They can be quick to respond with anger and aggression to criticism, in an attempt to protect their grandiose yet fragile sense of self. A 2021 UK study found they experience more paranoia, even when there is no evidence of people meaning to harm them, compared with people with lower levels of narcissism.

Similarly, recent research by US psychologists found that narcissistic people experienced heightened fear of being left out, and accused others of deliberately ostracising them when there was no evidence to support their belief.

The study found that participants high in narcissistic traits were more likely to interpret ambiguous social cues as rejection (for instance, a delayed text message). This suggests their perceptions of social behaviour may be distorted.

Narcissism and ostracism fuel one another

Narcissism can be expressed in “vulnerable” features (socially-inhibited and neurotic) as well as “grandiose” features (dominant and extroverted). People with more grandiose features are overtly assertive and self-promoting. People with more vulnerable features tend to be outwardly distressed, hypersensitive and inhibited.

Although these are separate forms of narcissism, they share a core of entitlement and an antagonistic character style. And just like we all exhibit varying degrees of narcissistic traits, we also fluctuate between these two expressions of narcissism.

The US researchers chose to focus on grandiose narcissism only. The study differentiated between two facets of grandiose narcissism: narcissistic admiration (the ability to charm and manipulate people) and narcissistic rivalry, which includes devaluing and acting aggressively towards others.

The research team analysed data for more than 77,000 participants from a series of seven studies by other scientists spanning 2009-2022. The first two studies investigated the relationship between narcissism and ostracism using surveys and experience sampling (a method used to investigate participants’ cognition and behaviour outside the lab – for example, using participants’ smartphones to track their behaviour).

The first study found people who reported higher narcissism levels said they experienced significantly more ostracism, compared with other participants. This was backed up by the second study, in which participants completed the narcissism assessments then reported feelings of ostracism within a 14-day period, using a mobile app.

The remaining experiments examined how people with higher levels of narcissism perceive ambiguous social interactions, and how others respond to narcissistic traits. After a group task, people with higher traits in narcissistic rivalry were more likely ostracised, even when other participants weren’t told the target had elevated levels of narcissism.

This supports the findings of a 2017 meta-study showing that people high in narcissistic rivalry may provoke direct conflict through their behaviour, and perceive others more negatively.

The US researchers concluded that, while narcissistic features can fuel social exclusion, ostracism itself can, over time, contribute to pronounced narcissistic traits. It appears that ostracism can make people already high in narcissism even higher in these traits.

Other research has similarly shown disparity between the narcissistic self and reality, and the role paranoia plays in this relationship. For instance, a 2015 study found that elevated levels of narcissism are associated with belief in conspiracy theories. This association was driven by paranoid thought.

These findings are concerning given the harmful consequences of conspiracy theories for society. They can fuel violence, climate denial and vaccine hesitancy.

Narcissistic personality features also tend to be higher among political leaders than the general population. Conspiracy theories may be appealing to politicians – particularly during times that challenge their entitled need for superiority and power.

The ideal self and the actual self

The US study’s findings carry practical implications for interventions aimed at people with high levels of narcissism. The researchers said interventions should not only try to improve relationships by identifying personality risk factors (in this instance, the rivalry component of narcissism), but also consider the perceptions of the person involved.

Narcissistic personality disorder comes with a higher risk of suicide and mental health difficulties, and treatment rarely makes much difference. This is partly because of patients’ resistance to abandoning the “ideal self”, leading to frustration, anger and conflict with their therapist.

But some interventions could target the cognitive distortions of narcissistic people that hamper their ability to function in society. For example, psychological therapies could aim to help them process the defensive mechanisms (overvaluing themselves) that mask underlying feelings of vulnerability.

Helping narcissistic people develop greater insights into their habitual reactions – such as responding aggressively to self-esteem threats and feelings of social exclusion – could help them foster skills that reshape their cognitive distortions. This could ameliorate distress, anger and hostility for narcissistic people – and the people around them.

According to the World Health Organization (WHO), more women are affected by depression than men. This pattern is seen in countries around the world, including the United States.

Cross-national and cross-cultural studies have indicated that the prevalence of depression among women is higher at any given time than among men. This pattern does not seem to have many exceptions.

Why is that? Biological differences between men and women, like hormones, explain part of it. These are examples of sex differences. But social factors between men and women (gender differences) may play a bigger role. For instance, women, in general, experience more stress than men, and research has shown that social stress is a main cause of depression.

But, new research that I’ve conducted with my colleague Maryam Moghani Lankarani suggests that men might be more vulnerable to depression caused by stressful events.

Why are more women depressed than men?

Researchers have defined stress as any major changes to the status quo (existing balance) that may potentially cause mental or emotional strain or tension. These stressful life events can include marriage, divorce, separation, marital reconciliation, personal injury or illness, dismissal from work or retirement.

Men are more likely to have depressive episodes following work difficulties, divorce and separation. Women, on the other hand, are more sensitive to conflict, serious illness or death happening in their close social network. In fact, research suggests that most of the stressful events that cause depression among women are related to their close social network, such as romantic and marital relationships, child-rearing and parenting.

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Research suggests that compared to men, women tend to ruminate (the technical term for “overthinking”) more about stressors and have negative thoughts that cause depression. And at least one study suggests that this explains the gender difference in the prevalence of depression. Rumination can make stress worse, and unfortunately, it is more common among women.

These findings suggest that psychosocial causes of depression may be at least partially gender-specific, and that these disparities are rooted in different life conditions – social inequalities – that men and women experience. And, in general, women tend to experience greater social inequality and social stress, and therefore depression, than men.

The gender gap in depression is largest in countries with highest gender inequalities. Gender difference in burden of depression is highest in the countries where women and men differ more in access to resources and social equity.

And that, oddly, might explain why men might be more susceptible to the depression-inducing effects of stress. They aren’t as used to dealing with it.

Men are more vulnerable to the effects of stress over time

In new research, my colleague Maryam Moghani Lankarani and I found that stressful life events are more likely to predict depression in men than in women.

In fact, men are more susceptible to the depression-inducing effects of each additional stressor over long-term periods.

We looked at data from a nationally representative study that examined how psychological factors affect physical and mental health of individuals over time.

We studied the effects of stressful life events men and women reported at the beginning of the study to their rates of depression 25 years later. We found that the effect of each life stressor on the risk of clinical depression was 50 percent stronger for men than women.

These findings correspond with a study we published in late 2015 that showed white men may be most vulnerable to the effect of stress on depression, possibly because they have a lower exposure to stress compared to any other demographic group.

It’s possible that cumulative exposure to stress may build resilience or habituation to stressors. In other words, people who cope with stress all the time can get used to it.

So the social group exposed to the lowest stressors (living the most privileged life) may at the same time be most vulnerable to each additional stressor. They have not learned to cope with stress as effectively as those who experience it more.

This is potentially the cost of living an easier, and therefore, less stressful life.

Men who experience depression may not seek care

Men may also be vulnerable to the effects of stress because they may perceive depression as a weakness. They may also define talking about emotion, and seeking help for an emotional problem, such as depression, as a weakness. This is especially the case in developing countries where traditional gender roles are more strongly endorsed.

These beliefs strongly shape behaviors of men who are in need of mental health care, and make men vulnerable when stress and emotional problem happens. All these result in men ignoring depression when it develops, and avoiding care when needed, not to look weak.

This also partially explains why more men with depression kill themselves (particularly white men) than women with depression.

Gender influences our risk of depression through various ways. It determines our risk of exposure to adversity. It changes our vulnerability to stress. And it can also determine what resources we’ll be able to access to cope with stress or depression.

A virtual therapy appointment can happen from your kitchen table, parked car, bedroom, or office. That flexibility is meaningful, but it also means the quality of the experience depends on more than clicking a video link. The best practices for virtual therapy help you protect your privacy, feel more present, and build a working relationship with a provider who understands what you need.

Online therapy is not a lesser version of care. For many people, it removes barriers such as transportation, scheduling conflicts, mobility limitations, and the discomfort of walking into an unfamiliar office. Still, it works best when you treat the session as protected time rather than one more task squeezed between errands.

Start With the Right Provider Fit

A therapist can be qualified and compassionate yet still not be the right match for you. Virtual care makes it easier to access professionals with different specialties, approaches, availability, and price points, so take advantage of that range.

Start by thinking about why you are seeking support. You may want help with anxiety, depression, grief, relationship concerns, trauma, life transitions, burnout, or a pattern you cannot quite name. A clear answer is helpful, but you do not need to have everything figured out before reaching out. “I have been overwhelmed for months and I do not know where to start” is a perfectly valid reason to begin therapy.

Ask potential providers about their experience with your concerns, their therapeutic approach, session format, availability, fees, and cancellation policy. If you plan to use insurance, verify coverage directly with your insurer and ask about your expected out-of-pocket cost. Transparency early on prevents financial surprises from getting in the way of care later.

Credentials matter, too. Your provider should be appropriately licensed to practice with clients in the state where you are physically located during sessions. This can be especially relevant if you travel often, attend college in another state, or split time between homes. A carefully vetted matching platform such as TheraConnect can make it easier to find providers whose qualifications and areas of focus align with your needs.

Prepare a Space That Feels Private Enough

You do not need a picture-perfect home office for effective virtual therapy. You do need a place where you can speak honestly without worrying that someone is listening nearby.

If possible, choose a room with a door, use headphones, and let household members know you need uninterrupted time. A fan, white-noise machine, or low background sound outside the room may help if privacy is limited. If home is not private, consider whether you can use a confidential room at work, sit in a parked car in a safe location, or ask your provider about flexible options.

Privacy is not only about who can hear you. Use a personal device when you can, keep your screen out of view of others, and avoid public Wi-Fi for sessions. Password-protect your phone or computer and update the software used for video calls. These small choices reduce the chance that sensitive information is exposed.

Before your first session, test your camera, microphone, internet connection, and device charger. Keep your provider’s office number or support contact available in case the video connection drops. Technology problems happen. Having a backup plan means a brief disruption does not have to derail the appointment.

Treat the Session Like an Appointment, Not Background Noise

One of the most useful best practices for virtual therapy is creating a transition into the session. In an office setting, the commute and waiting room naturally separate therapy from the rest of the day. At home, you may need to create that boundary yourself.

Try to arrive a few minutes early. Get a glass of water, silence notifications, and close unrelated browser tabs. If you have been rushing from work, parenting, or caregiving, take a minute to notice what is happening in your body. A few slow breaths or a short walk around the room can help you shift your attention.

During the session, resist the urge to multitask. Avoid checking email, folding laundry, scrolling, or responding to messages. You do not need to perform perfectly for your therapist, but being as present as possible gives you both more to work with.

It can also help to keep a notebook nearby. Write down topics that come up between appointments, questions you want to ask, or a feeling you want to understand better. You are not required to bring a polished agenda, but a few notes can be useful on days when your mind goes blank after, “How have you been?”

Be Honest About What Is and Is Not Working

Therapy is collaborative. Your provider brings training, perspective, and structure; you bring your lived experience, goals, and honest feedback. The relationship becomes more useful when both people can talk openly about the process itself.

Tell your therapist if you feel confused by an exercise, uncomfortable with a question, unsure about your goals, or dissatisfied with the pace of therapy. You can say, “I think I need more practical tools,” or “I want to spend more time on what happened this week.” That is not being difficult. It is valuable information that helps your provider tailor care.

The same applies to virtual logistics. Maybe video calls make you feel distracted, maybe you need a different appointment time, or maybe you prefer a phone session when your internet is unreliable. Discuss it. There are trade-offs with every format, and the best arrangement is the one that supports consistent, meaningful participation.

A strong therapeutic connection does not mean every session feels comfortable. Some conversations may bring up sadness, anger, uncertainty, or relief. What matters is whether you generally feel respected, heard, and able to be truthful. If that foundation is missing after you have given the relationship a fair chance, it may be time to explore another provider.

Know How Privacy and Safety Work Online

Your therapist should explain confidentiality, informed consent, payment practices, communication boundaries, and what happens in an emergency. Ask questions before you need the answers. For example, find out whether your provider uses a secure telehealth system, how they handle messages between sessions, and what to do if you are in immediate danger.

At the beginning of virtual care, many providers will confirm your current location and an emergency contact. This is standard safety planning, not an invasion of privacy. Because your therapist is not physically in the room, they need enough information to respond appropriately if a serious crisis arises.

Virtual therapy is not always the right level of support for every situation. If you are at immediate risk of harming yourself or someone else, call 911, go to the nearest emergency room, or contact 988 for the Suicide & Crisis Lifeline. If your symptoms are becoming more intense between sessions, tell your provider as soon as possible so you can discuss a safer, more appropriate plan.

Make Space for What Happens After the Call

The end of a virtual session can feel abrupt. One moment you are talking about a painful memory; the next, you are back in the same room where you answer emails or make dinner. Build in a small buffer when you can.

Give yourself five or ten minutes before jumping into another responsibility. Write down a takeaway, step outside, drink water, or simply sit quietly. You do not have to turn every session into homework, but reflection can help you carry the conversation into daily life.

Progress rarely moves in a straight line. Some weeks bring insight; others simply help you get through a hard day with a little more support. Keep showing up, speak honestly, and let the process adjust as your needs change. The right virtual therapy setup should make care feel more reachable, not harder to hold onto.

Mariah Carey recently opened up about her struggle with bipolar disorder.

As an assistant professor of psychiatry, I see her courage as an opportunity to explain bipolar disorder, a mood disorder that includes episodes of elevated mood, as well as episodes of depression.

There are two common types: Bipolar I disorder includes manic episodes in which a person experiences heightened or, at times, an irritable mood, for at least a week. This includes high energy, inflated self-esteem, reduced need for sleep, talkativeness or pressured speech, overspending, reckless risky behavior, racing thoughts, increased goal-directed behavior and a substantially increased sex drive. Symptoms are a clear departure from person’s baseline behavior. A patient in a manic episode may have all or some of these symptoms, none of which are induced by drug use.

Bipolar II disorder includes hypomanic episodes, a mood episode that includes the same symptoms at lower severity for a shorter time (four days at least) and without significant impairment of person’s functioning.

It is important to note the required duration of days to avoid a common mistake: Too often people are labeled with this diagnosis because of emotional instability or changes in mood over the course of hours, as a result of stressful events or other psychiatric conditions. I always make sure patients who believe they have this condition know the definition and substantial sustained nature of the episodes.

Diagnosis is mostly based upon psychiatric interviews and a review of the history of previous episodes or current symptoms, if the patient is experiencing a manic/hypomanic episode at the time of psychiatric examination. Historical data could be based on patient’s report, collateral information from family members, or psychiatric records. A history of a manic or hypomanic episode, not justified by medical conditions or drug use, is enough to make the diagnosis.

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It is also important to know that the majority of the episodes of mood change in a person with bipolar disorder are of the depressed nature and not manic/hypomanic. That is, a person with bipolar disorder usually experiences more depressive episodes than manic ones.

Treatment is vital to prevent future manic or depressive episodes and to reduce the severity of those that emerge. A manic episode can ruin a marriage, a bank account, or a job, or it can even lead to legal consequences.

Treatment usually involves mood stabilizer medications that reduce the chance and severity of future episodes. Mood stabilizers often are the same medications that are used for treatment of epilepsy, and some belong to other categories of psychiatric medications. Reduction of stress and close monitoring of mood by the patient, their family and physician can prevent the emergence of a new episode or its exacerbation.

A college student takes her first therapy session from a parked car between classes. A new parent talks quietly during nap time. A retiree meets with a therapist without arranging a long drive or asking someone for a ride. These are the settings behind many success stories of online therapy – not picture-perfect transformations, but real people making room for support in lives that are already full.

Online therapy is not the right fit for every person or every clinical need. But for many people, virtual care removes barriers that once kept therapy out of reach: distance, scheduling, transportation, cost concerns, and the discomfort of walking into an unfamiliar office. When the therapist, format, and goals align, that easier access can turn into meaningful change.

What Online Therapy Success Can Actually Look Like

The most valuable therapy outcomes are not always dramatic. Someone may not wake up one day feeling permanently free of anxiety, grief, or stress. More often, progress shows up in smaller, sturdier moments: pausing before reacting, setting one honest boundary, sleeping a little better, or recognizing a harmful thought pattern before it takes over the day.

That distinction matters. Therapy is not a performance, and success is not measured by how quickly someone can say they are “fixed.” It is measured by whether care helps them understand themselves, cope more effectively, and make choices that fit the life they want to build.

For online clients, the format itself can be part of the progress. Meeting from a familiar environment may make it easier to open up. Having an appointment without a commute can mean fewer missed sessions. For a person in a rural area, a virtual platform may offer access to a therapist with experience in concerns that local options do not cover.

From Constant Worry to Practical Confidence

Consider a working professional who starts therapy because worry has become the background noise of every day. She is checking email late at night, replaying conversations, and assuming a mistake at work will lead to disaster. She has considered therapy before, but a traditional appointment would require time away from work and a drive across town.

With online sessions, she can meet with a licensed therapist during a break at home. Early conversations focus on understanding her anxiety rather than judging it. Together, they identify the cycle: a stressful thought leads to reassurance-seeking, which brings short-term relief but makes the worry return stronger.

Over time, she practices skills between appointments. She learns to name catastrophic thinking, set a reasonable cutoff for work messages, and sit with uncertainty without immediately trying to erase it. Her anxiety does not vanish. What changes is her relationship to it. She has more confidence that a difficult feeling can be managed without controlling her entire day.

That is a realistic therapy success story: less time trapped in the spiral, more time present in her own life.

When Convenience Makes Consistency Possible

A parent may begin online therapy after realizing that irritability and exhaustion are affecting family life. Finding child care for an in-person appointment feels impossible, and canceling at the last minute creates more guilt. Virtual sessions make it possible to meet after the children are asleep or during a protected window in the workday.

The therapist does not offer a magic solution for the demands of parenting. Instead, the work may center on burnout, communication, self-compassion, and asking for help before resentment builds. The client begins noticing the difference between having a bad day and believing they are a bad parent.

Consistency is often the turning point. Therapy gives the person a regular place to speak honestly, reflect on what is happening, and try a different response the next week. A flexible format cannot solve every scheduling challenge, but it can make ongoing care more realistic for people whose responsibilities leave little room for themselves.

Healing After a Relationship Ends

Breakups, divorce, and estrangement can make people question their judgment and identity. One client may come to online therapy after months of rereading old messages, blaming herself for everything, and withdrawing from friends. The privacy of a session at home feels less intimidating than entering a waiting room while she is emotionally raw.

In therapy, she starts separating facts from self-blame. She explores why certain patterns in the relationship felt familiar and what she wants to do differently next time. She reconnects with friends, returns to hobbies she had stopped enjoying, and learns that loneliness does not mean she should accept treatment that hurts her.

The success is not that she never feels sad again. Grief has its own timeline. The success is that she stops treating her pain as evidence that she is unworthy of care, respect, or a healthier future.

Why the Right Match Matters in Online Therapy

The strongest success stories of online therapy usually have one thing in common: the client feels understood by their therapist. Credentials matter, and so does connection. A therapist can be highly qualified while still not being the best fit for a particular person’s communication style, cultural background, goals, budget, or concerns.

A good match does not mean every session feels easy. Therapy can bring up discomfort, especially when someone is addressing trauma, loss, shame, or long-standing patterns. It means the client feels respected enough to be honest, ask questions, and say when an approach is not working.

Before committing, it can help to ask a prospective therapist about their experience with your primary concern, their approach to treatment, fees, insurance or sliding-scale options, and how they handle telehealth sessions. You can also ask what progress might reasonably look like in the first few months. No ethical professional can promise a specific outcome, but they should be able to explain how they work and invite your input.

TheraConnect is built around that need for fit. Clients can sign up at no cost and connect with vetted mental health professionals based on the care, availability, and budget that make sense for them. The goal is not simply to find any appointment. It is to reduce the friction between needing support and finding a provider who feels like a workable match.

The Trade-Offs Are Worth Understanding

Virtual therapy has clear benefits, but being realistic about its limits helps people make better decisions. Privacy can be difficult if you share a home, have thin walls, or do not have a reliable place to talk. Some clients use headphones, sit in a parked car, or schedule sessions when the home is quieter. Still, a private setting is an important part of feeling safe enough to speak freely.

Technology can also be frustrating. An unstable connection interrupts the flow of a vulnerable conversation. It is wise to have a backup plan with your therapist, such as switching to phone audio if video fails.

There are also situations where online care may not provide enough support on its own. A person in immediate danger, experiencing a mental health crisis, or needing intensive treatment should seek urgent local help or contact emergency services. A qualified therapist can help assess the appropriate level of care, but telehealth is not a substitute for emergency intervention.

For some people, in-person sessions simply feel better. They value the physical separation between home and therapy, nonverbal cues that are easier to notice in person, or the routine of going to a dedicated office. Choosing in-person care is not a failure to embrace convenience. It is a preference, and preferences matter in mental health care.

How to Give Online Therapy a Fair Chance

The first session is often more about orientation than deep healing. You may be asked about your history, current concerns, goals, and practical needs. It is normal to feel uncertain or to struggle to explain what is wrong. “I do not know where to start” is a completely acceptable place to start.

Try to protect the appointment as much as possible. Choose a private location, silence notifications, and give yourself a few minutes afterward before jumping into another obligation. If you can, keep a brief note between sessions about moments you want to discuss. That could be a conflict, a recurring feeling, a small win, or a question you did not know how to ask in the moment.

Most importantly, speak up about fit. If you need more structure, want clearer feedback, prefer a different pace, or do not feel comfortable after several sessions, say so. Sometimes a therapist can adjust. Sometimes changing providers is the healthier choice. Finding the right support can take effort, but it is effort directed toward your well-being.

A meaningful change may begin with something as simple as attending one conversation from a place where you feel safe. When you are ready, check your options, ask the questions that matter to you, and let the next small step be enough for today.

Postpartum depression can affect anyone, and it often sneaks in quietly, like a shadow in the corners of a new mother’s life. It presents significant challenges for around 1 in 7 new mothers, affecting their emotional well-being and overall quality of life and that of the newborn.

Many – if not most – women experience the “baby blues,” or generalized feelings of sadness, worry, unhappiness and exhaustion, in the initial days after giving birth. In most cases, these mood changes are resolved in the first two weeks after having a baby. In contrast, the symptoms of postpartum depression endure for more extended periods, sometimes lingering for up to three years.

The symptoms can also start during pregnancy. Research shows that more than half of women who experience depression symptoms during pregnancy will develop postpartum depression too.

A much more rare and severe psychiatric disorder following delivery is called postpartum psychosis. Its onset is rapid and severe, with hallucinations, delusions and emotional distress, along with bizarre and sometimes dangerous behaviors. About 1 or 2 in 1,000 women experience postpartum psychosis after giving birth.

We are a clinical nurse specialist and a licensed mental health counselor, and together we have over 45 years of experience as educators and clinicians.

With proper awareness, education and intervention, perinatal mood disorders are nearly 100% treatable. We want women to realize that they are not alone, they are not to blame, and with help they can be well again.

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Crying, sadness and lack of bonding

Following pregnancy, many women experience normal changes that can mimic symptoms of depression, such as sadness, worry and exhaustion. The transition to motherhood, particularly with a new baby in the home, can be overwhelming. However, it’s essential to distinguish between these common adjustments and more concerning signs of depression.

If you or someone you know finds themselves experiencing any of the following symptoms persistently for over two weeks after giving birth, it’s crucial they reach out to their doctor, nurse or midwife. Here are some of the most-reported symptoms of postpartum depression:

• Lack of bonding and feeling disconnected from the baby or experiencing a lack of interest in them.
• Restlessness or moodiness and feeling unusually agitated or irritable.
• Persistent feelings of sadness, hopelessness or being overwhelmed.
• Experiencing physical symptoms such as persistent headaches, other body aches and pains or digestive issues that don’t resolve.
• A profound lack of energy or motivation, making daily tasks feel daunting.
• Significant changes in appetite and either eating too little or too much.
• Disturbed sleep patterns, such as sleeping too much or too little, even when given the opportunity to rest.
• Difficulty concentrating or making decisions, or experiencing memory problems.
• Overwhelming feelings of guilt, worthlessness or inadequacy as a mother.
• A notable decline in interest or pleasure in activities previously enjoyed.
• Isolating from friends and family, avoiding social interactions.
• Thoughts of harming the baby or themselves. These should be taken extremely seriously and warrant immediate attention.

Some risk factors associated with higher likelihood of postpartum depression include life stress, depression history, maternal anxiety, lack of social support, infrequent exercise, unintended pregnancy and intimate partner violence.

Real-life examples

People dealing with depression not only have to manage their symptoms but may also face the stigma and discrimination that these conditions often bring. There is an expectation that new parents will be happy after delivery. Sadness, stigma, shame or guilt greatly affects a person’s willingness to seek help. Studies show that many people opt not to seek treatment to avoid being perceived as unfit parents by health care providers or family.

As a nurse and a mom who has experienced postpartum depression, I (Nicole Lynch) frequently share my story with others. Years ago, another mom shared with me how helpful it was to hear that she wasn’t alone. Knowing that other women – dedicated parents who love their children – can feel this way and that things can get better gave her hope.

Throughout my career, I (Shannon Pickett) have worked with several mothers and prospective parents who have struggled with postpartum depression. For instance, I worked with one woman for several years about her anxiety and her struggle to conceive. After years of trying, she finally became pregnant. Both she and her husband were overjoyed and could not wait to become parents.

The pregnancy went smoothly and there were no complications. She had never shown any signs of depression previously, but once the baby was born, that changed. My client had trouble bonding with the baby and did not want to hold or console her new son when he needed soothing.

Her husband would often step in to comfort the infant and would ask my client, “What is wrong with you?” It caused frustration within their marriage because the father felt as though he was doing the caregiving alone and that my client was withdrawn. She had planned to take a break from therapy for a bit after the baby was born, but her husband encouraged her to reach out to schedule an appointment.

I could tell right away that she was struggling with postpartum depression. She barely smiled, had difficulty engaging in and concentrating on our conversation and cried throughout most of the session.

We talked a lot about the guilt she felt over not wanting to be around her son or hold him, even though she had fought for so long to become a mother. After receiving a proper diagnosis and starting an antidepressant medication, my client was able to recover and bond with her son. The medication did take a few weeks to get into her system, so the results were not instant. Maintaining her sessions and using her support system were important for her recovery as well.

Heightened risk

While postpartum depression can affect anyone regardless of their socioeconomic status or their background, some women affected by social inequalities have increased risk of many common postpartum mental disorders and their adverse consequences.

One study found that new mothers with low incomes, those who had not earned a college degree, were unmarried or were unemployed were 11 times more likely than women with no risk factors to have clinically elevated depression scores three months after having a baby.

Inadequate support

The Centers for Disease Control and Prevention estimates that about 20% of pregnant women were not asked about depression during a prenatal visit, and more than half of women with postpartum depression remain untreated for their symptoms.

What’s worse, there is a lack of access to mental health services for women after delivery. Many promising treatments are underexplored, especially in scientific studies. While more people are talking about postpartum depression, there is still stigma around seeking help.

A new medication offers hope

It’s vital to remember that postpartum depression is a treatable condition. Seeking help from health care professionals is a courageous and necessary step.

In August 2023, the Food and Drug Administration approved the first oral medication, Zurzuvae, specifically intended to treat severe depression after childbirth. It holds promise for addressing the complex array of symptoms associated with postpartum depression and offers newfound hope for affected mothers and their families.

If you are experiencing symptoms of postpartum depression, consider finding a therapist in your community for either telehealth or in-person sessions.

There are also postpartum support groups that meet in person and online.

Supportive therapies, including counseling, medication and lifestyle adjustments, can significantly alleviate symptoms and improve overall well-being. Early intervention is key to a faster and more complete recovery, ensuring that mothers can enjoy the precious moments with their baby and find fulfillment in motherhood.

By Peg O Connor

We tend to shrink ourselves and our world when we lack self-respect.

ey points

• Active in our addictions, we shrink ourselves so that we and our use may go unnoticed.
• We may believe that we do not deserve to take up space in the world, which is a deficit of self-respect.
• Self-respect is an achievement of moral development that depends on love, care, and support.
• Addictions can cause us to lose self-respect. Does a deficit of self-respect contribute to addiction?

Active in our addictions, our worlds often shrink. We prune people from our lives who question our use. We remove ourselves from events and activities that once brought us joy. We become less willing to do or try new things. Where before possibilities had seemed like opportunities, now they just feel daunting and even threatening.

We make ourselves smaller. We start to take up less space in our own lives. As someone once said, I felt like a mouse running around the trim board of my own life. Our making ourselves smaller goes hand in hand with our social and physical worlds contracting; they aid and abet each other.

Why do we skitter around the margins of our own lives?

Some of us want to go unnoticed. We may tell ourselves, better to stay off the radar screen than have people judging us. We may take our not being noticed as evidence that we aren’t doing so badly.

If people do notice us and our use, we may automatically assume that they are judging us in the same harsh ways that we judge ourselves. Of course, there are plenty of instances when this is true. We cannot even imagine that they are standing by us and offering their support because, well, we don’t deserve it.

Others of us believe that we do not deserve to take up space in anyone’s life, including our own. This is especially true for people who lack self-respect.

Self-respect

Self-respect is an achievement within moral development; it is a lived conviction that a person has intrinsic worth and dignity. It is a basic sense that “I matter.” Self-respect is created against a background of care, love, and security. A person develops self-respect through having the opportunities to engage with others. Self-respect is not innate.

A person with self-respect understands that she deserves to be treated respectfully by others because she has the same moral worth as everyone else. She also understands that she needs to treat herself in ways that recognize and preserve her dignity and autonomy.

Self-respect is what enables a person to judge that she is measuring up not just to others but to her own standards. When a person with self-respect recognizes that she is not meeting her own measure, she may change her actions so that she preserves her self-respect.

Self-respect and addiction

Self-respect is easily lost in addiction. There are many cases where a person has had self-respect but has lost it, often through their own actions. Someone who has had a good, meaningful, and happy life may lose respect for himself when he develops an addiction later in life and begins to act in ways that are out of character.

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We may start trading away our values and commitments. We may do things that cut against our grain. Instead of seeing ourselves as having dignity and worth, we come to see ourselves as insignificant and worthless. We start to treat ourselves this way.

The more we feel worthless, the more we contract into ourselves. In the worst throes of addiction, the world is reduced to us and our substances and behaviors. Our minds and the entire world may seem like a hellscape.

Some people have only ever had a very small degree of self-respect because they never had the opportunity to develop the skills and arts that underpin self-respect. Where love, care, and security are missing, it becomes far more difficult for a child to develop the arts and skills that are necessary to create, reinforce, and cherish self-respect.

Children who have been traumatized may have had many of the opportunities necessary to develop self-respect foreclosed. A child who has never been treated with love and respect or treated in ways that twine abuse with love will not have the opportunities to learn how to create, act on, and protect their self-respect. They have not been treated respectfully by others, so it is challenging to learn how to treat themselves and have a clear sense of what they rightly deserve.

Traumatized children, and later adolescents and adults, are more likely to develop an addiction than children who have not been traumatized.

While a loss of self-respect is a consequence of addiction, I believe a lack of self-respect is also a driving force of addiction. People who have experienced childhood trauma and haven’t been able to practice self-respect have already known a world of pain, insecurity, and uncertainty. They may already have a sense of just how unfair the world is along with a fatalism about their place in it. They understand what it is like to have few good opportunities available to them. They see others around them suffering and can’t even imagine their lives going differently.

When a person believes she has no value and that people like her deserve no better, the allure of addictive substances and behaviors may seem great. She may know that her world is full of pain and suffering; shrinking that world and finding some relief from the suffering makes sense.

Those addictive substances and behaviors can also ignite a sense of being alive, having fun, and making connections to others, all of which childhood trauma hinders. The addictive substances and behaviors most often bring us something we want or need in the beginning. Their bill comes due at some point, putting whatever shards of self-respect a person has at risk.

In recovery, we begin to gain or regain self-respect, which is crucial to flourishing.