Reader’s Question

My psychologist agrees that I have a lot of the symptoms associated with borderline personality disorder, but I haven’t been in any romantic relationships because I know I’d be a horrible partner. Does not being in a relationship mean I can’t have BPD?

Psychologist’s Reply

Not having been in a romantic relationship doesn’t necessarily mean that you can’t have borderline personality disorder. BPD can seriously impact relationships, but there are many other important symptoms associated with this personality disorder. The symptoms can range from mild to severe, but typically there tends to be an unstable sense of self, risky or impulsive behaviors (often including things like spending, sex, suicide/self-injury or even substance abuse), significant mood swings, a chronic feeling of emptiness, frequent anger and outbursts and sometimes paranoia or feeling disconnected from the present moment. (To read more on BPD, see the NIMH overview.)

There are certain aspects of BPD that can really damage a relationship. Those with BPD often experience intense, frantic efforts to avoid real or imagined abandonment. People with the disorder are often very sensitive and devastated by the feelings that come with loss and abandonment, whether the situation is real or just feared. These emotions are typically difficult for them and often lead to negative behaviors. For example, they may become inappropriately or disproportionately upset when their partner is late for lunch or doesn’t return a text in a timely manner. The fear of abandonment or rejection can lead to manipulative attempts to prevent the other person from leaving through the use of shame, guilt and anger. Persistent manipulation can easily drive their partners away, the exact thing they were hoping to avoid. The fear of rejection and abandonment can also contribute to high levels of distrust that could prevent the person with BPD from even wanting a relationship for fear of encountering those feelings. I’ve heard some with BPD even say they would rather be alone then potentially face those issues in a relationship.

Individuals with BPD are also prone to sudden or dramatic shifts in their views of others. These shifting views can often be very confusing for their partners, who wonder if they are loved or hated by them. Often they may idealize their caregivers or romantic partners and want to spend all of their time with them, quickly become attached, and share their deep personal secrets early in the relationship — only to suddenly shift and devalue the person. They may begin to feel the person does not care enough or put enough effort into the relationship and quickly become distrustful of them. Some studies have suggested that those with BPD have patterns of brain activity associated with disruptions in the ability to recognize social norms or modify impulsive behaviors and reactions.

Despite these issues, there is treatment available, including learning relationship skills that can help ensure a good, healthy relationship. There are proven and effective treatment strategies (like Dialectical Behavior Therapy, or DBT, and Interpersonal or Relational Therapies) that help those who struggle with the disorder. Even couples therapy can be used to help in addition to these. Many of those who suffer with BPD can experience repetitive disappointment and emotional pain from their relationships over time that lead them to strongly believe that love and commitment are out of reach. Try not to believe that. These valuable things are within reach for anyone, including those suffering with borderline personality disorder; it just takes commitment to treatment and partners who are willing to be patient.

Reader’s Question

I am a 31-year-old male. I can’t trust anyone. Due to many experiences through my life I don’t see how anyone can be trusted. People get what they need from others and throw them aside once their usefulness is over. Like the rest of humanity I will always have the desire to want to be close to someone, but with not being able to trust anyone I don’t see how that will ever be possible. How can one learn to trust without going through the hurt all over again?

Psychologist’s Reply

Trust can be one of the most important parts of a relationship; the lack of trust can be the most damaging as well. Nonetheless, your difficulty in trusting others is not all that uncommon. This difficulty in trusting others may develop for many reasons. The most common reasons for this include previous negative experiences in relationships that have either aided the individual in developing fears of being hurt or simply just reinforced fears that were already there or learned. We know that trust starts very early for all of us when we are infants and dependent upon our caretakers to feed us, protect us, and comfort us. Sometimes, we over attach to the same sex parent and never develop the trusting bond with others of the opposite sex. When those around us fail to caretake, it can impact our trust of others later in life. Failing to learn to trust can lead to emotional distance in close relationships. The good news is that even if we do not experience trust early in life, we can learn to do so again.

The first step in learning to trust again is to understand that it is innate in all of us to trust and attach to other people. Despite being hurt in relationships previously, I believe this need stays around. However, it puts us in that place of wanting to trust people but feeling afraid to make it happen. We want to be close and intimate, distant from our loneliness, but are scared to do anything about it. Recognizing we need to trust others brings up uncomfortable feelings of vulnerability. Being vulnerable is a very difficult place for us to be. Some of us would rather stay safe than feel vulnerable. I see many people settle for safe and alone, sacrificing being happy and attached.

I think we have to be willing to put ourselves at risk to move forward. A difficult reality to face is that we might get hurt again. However, sometimes, that is the consequence of attachment. For many of us, we have to learn that, although the pain is great when we are hurt, it won’t kill us. It will be difficult, but we won’t die. We really have to believe we will survive a relationship ending and come out OK in the end. This can take time, and one certainly has to grieve and begin to move through the loss before doing so. Once you achieve this, you’re ready to go on to the next step.

To help along the way, here are some tips:

Take your time.

Like really take your time. After being hurt and going through a loss we need time to psychologically recover. We need distance and time to heal, get things in perspective, and grieve. Often we are hit suddenly with feelings of loneliness and the temptation to jump right back into a relationship with that person or someone new can be overwhelming. We need time to be single, with ourselves, and alone. This is often a substantial period of time when we grow tremendously. Allow yourself the privilege of that growth.

Be safe.

I don’t want this to sound contradictory to what I previously said about being safe. What I am talking about here is more the idea of making healthier choices about who you choose to be vulnerable with. Simply traumatizing yourself in bad relationship after bad relationship will only make it more difficult for you in the long run. You can’t put yourself back into a situation or a new situation and rebuild trust unless you feel safe with the other person. We need to really reflect on the situations we place ourselves in and decide if these were the best situations for us to be in or go back to. For many couples I work with in which one person has cheated, the couple often needs space to heal and then to feel safe with the other person before they can even begin to talk about rebuilding trust. If you can’t go back to a situation that can provide you with feeling safe, then I often recommend not going back.

Be open.

Finally, when in a new relationship, be willing to talk about your reservations and fears. Be open about your expectations and put your thoughts out on the table to give both of you a chance to try and work through them. Here’s where you get to practice being vulnerable, with the right person. Believe it or not, trust can actually develop from sharing and being vulnerable with others.

Reader’s Question

I often sit in the middle of the night stuck with my obsessive thinking about a topic. I try to name and understand my feelings related to my suicide attempt three years ago or two; I’m not so sure about the date. Sometimes when I think about my suicide attempt I feel weak and feel humiliated by own self. I am being consumed by the idea that the people who know about my attempt are thinking that I am weak, miserable and self-conscious about the fact that I attempted to end my life. In short I really want to know more about why I get this sinking feeling. I am proud to say that I am pretty curious about psychology and aware that what I am feeling is not normal. I have tried several times to find out about it but with no results. I hope you can help me by at least naming the feeling.

Psychologist’s Reply

I think what you feel may be what many who have been in your shoes have felt before: shame. It is that feeling of guilt, regret and sadness that we all feel at times in our life. Unfortunately, shame can be a very devastating emotion that can make our situation and struggles worse, not better. Shame is an emotion of disgrace and unworthiness that comes from inside of us. However, that is only part of what someone who is in recovery from a suicide attempt must face. There is another part that is just as crippling: stigma. Stigma comes from the world around us. Society sends that message that we are flawed in some way, weak and undeserving, and that what we have done is unforgivable or taboo.

There is significant stigma around people who have thought about suicide, who have tried to kill themselves or who have even completed suicide. The messages we receive about suicide from the media, our peers, and even our families portray those who are struggling with suicide as weak, crazy or defective, and selfish. This stigma is often quite harmful and does not account for facts about depression or about the chemicals in our brain. The stigma only serves to make those who struggle with depression and suicide feel more shameful. This can even lead to more suicidal thoughts. For some of my clients, it is a cycle that can go on and on.

Although attitudes toward suicide are slowly changing for the better — we’ve seen many people speak out on the stigma of suicide when Robin Williams died, for example — unfortunately, the stigma is still strong enough in our culture that it prevents most people, especially the elderly, from talking about it. Many people are afraid to talk about suicide, which only makes it more difficult to understand and help. If we are reluctant to say anything because of how others might react, we are less likely to seek help and support from those who can provide it. A good suicide prevention program seeks to remove the stigma associated with feeling this way.

There are many aspects to our society that are shaming towards those with depression and suicidal thoughts. We often say people “commit” suicide like they would “commit” a crime or a sin. This type of language has been used to try and shame people away from killing themselves. I understand that we as a society may have good intentions with this, but it only pushes those with depression to hide and not seek help they need. It only makes it worse.

Some of the most common thoughts expressed by my clients who have tried to suicide or were thinking about it are things like “I’m weak”, “I’m a burden to everyone” and “I must be crazy.” I’ve talked about these ideas before in my article “4 Myths About Suicide.” One of the worst things this stigma does is convince us that we need to hide our feelings and struggle on our own, alone. Feeling alone with our depression only serves to make it feel more intense. Often I hear my clients say that they won’t talk about it because family, friends, and doctors won’t understand. I can’t promise you that everyone you want to understand will (maybe because they have bought into the negative messages and stigma), but you are not alone. There are many out there who have had to deal with this just like you, and finding people who understand is helpful in recovering from a suicide attempt. Whether you find them in your family, friends, social network, or in a depression support group, it can be life changing. There are plenty of online resources as well to help you begin to understand what it means to recover from this, including at Waking Up Alive, What Happens Now?, and beyondblue. For many of us who know someone who is dealing with depression, we are often afraid to ask if they are thinking about suicide. Just asking, however, can go a long way toward helping reduce the stigma around it by saying it’s alright to talk about it.

Reader’s Question

Ever since I was a child I haven’t had many friends, and when I was getting bullied that number went to zero. I had to make friends with my teachers and after a while that’s what I was used to — sitting with them at lunch, talking to them at recess — and when I moved to a new school and made friends I kept that habit just in case my friends decided to bail on me. Now, whenever a teacher doesn’t like me it keeps me up at night, obsessing over every little thing that I might’ve done wrong. When I have a favorite teacher I always want to be there to help and relieve any stress they might have. But whenever I do something wrong or feel like I’m annoying them it’s devastating; I feel like I’m letting down a god. So my question is:

Is it unhealthy to put my teacher on this high of a pedestal and to want to be friends with them — not just to be friendly? Should I distance myself?

Psychologist’s Reply

It is very natural to admire teachers, to want to please them, and even to wish for friendships with them. Teachers often have qualities we wish for in ourselves — kindness, friendliness, wisdom, compassion, warmth -– and it is easy to become enamored of them. Teachers also pay attention to us, especially when we answer a question correctly or show effort in our work. Sometimes we make more meaning out of the attention, however, mistakenly thinking that we have a special relationship with a teacher that no one else has. All these thoughts and feelings are natural; it’s how we manage them and what we do with them that makes the difference.

I can understand how teachers have been especially kind to you, and how you feel their support and friendship when peers have not been as accepting (and have, instead, bullied). Sometimes when we have difficulty relating to others our own age (or, they have difficulty relating to us), we find much more in common with our teachers. However, while it is important to have our teachers and other trusted adults as our safety nets (much like you described when moving to a new school), it’s also important to continue to learn new ways to approach and make friendships with others our own age. Some teachers can help with these skills, but often a trusted counselor at the school or perhaps a licensed therapist or psychologist outside of school can offer specific tools for helping friendships and peer relationships go more smoothly.

Sometimes when individuals are concerned about what authority figures (like teachers) think of them, they can become anxious or flustered around them, and may also place them on a pedestal as you described. This can sometimes be a symptom of Social Anxiety Disorder, or Social Phobia. A qualified mental health practitioner can help determine if this might be going on for you, and if so, can offer structured ways to help you see teachers and other authority figures in a more realistic way. Teachers’ roles are to help their students learn, and students’ roles are to listen to their teachers and try their best with the lessons provided. When we come to misconstrue the relationship as closer, we begin to cross boundaries that have an important purpose — to ensure that students learn.

You also mentioned always wanting to be there for your teachers to help them with their stress. This is an important boundary that would be helpful for you to work on. It is not any child’s job to help alleviate stress in adults — it is the job of other adults with whom they have age-appropriate friendships and relationships. If a teacher becomes annoyed, it may be because they notice this boundary being crossed. Listening to the teacher, asking for help on school related concerns (both the learning material as well as peer conflicts), and following their directions is the appropriate way to have a good relationship with a teacher.

To answer your question, yes, it can be unhealthy for you to want an adult like friendship with your teachers. Rather than thinking of it as distancing, think about the healthy boundaries described above. Perhaps ask yourself how to channel your need to support and be friendly into your own peer relationships instead of those with your teachers. Once you start experimenting with putting more energy (with counselor support if needed) into your same age friendships, my guess is that you will get along better with your teachers, will have less worry about them, and will feel better about yourself, too.

Reader’s Question

I don’t know what to do anymore with my dad. When my parents divorced, I was 15 and I left with my dad. My whole life he always put me down, abused me in every way, manipulated me to believe anything, and even turned me against my mom. Everything he told me during the divorce turned out to be what he did, not her. So for 6 years I believed him, until I got with my husband and moved out at age 22. It turned out everything he said was a lie. He has changed me so badly that I can’t help but say sorry to anything, I blame myself for everything, I can’t take jokes no matter how small, I always put myself down, I always believe I have to do everything, and also I have to always please my father. It is now destroying my relationship with my husband. I have to call my father every day, see him once a week, and do anything he asks. I have tried so many times to end it but when he fights back, I’m not allowed to speak, he yells, fights, and even threatens to slap me. And every time I break down and back down to him. If I don’t do something soon I will lose my husband, son, everything I have. I don’t want to lose the first and only happiness in my life. He has destroyed me. I don’t know what to do and I need help.

Psychologist’s Reply

It sounds like you’ve been through some difficult years with your dad, but have also been able to gain perspective and notice the things that you don’t want to tolerate any longer. Moving out of his house seems like it was the first step to understanding his tactics as well as your own responses to them.

From your description, I get the sense that two things are happening:

1. Your father is who he is, and it is doubtful that much of that will change.
2. How you choose to respond to your father may give you more control in the relationship.

Sometimes, people feel powerless and trapped in the pattern of how they respond to others — especially parents. In these instances, it can be helpful to think about the amount of emotional and physical distance from your father that you might be able to tolerate. I noticed a lot of “have to’s” in your description, but I’m unsure what the consequences are if you don’t acquiesce. It sounds as if there are threats of abuse when and if you engage with him — and if someone is emotionally and physically abusive, there isn’t a healthy way to keep in contact with that individual until the abuse stops.

I’m wondering what keeps you connected to your father — is it out of obligation, the false hope of getting recognition from him, or something else? If he is willing to acknowledge and cease the abuse, I’m wondering if there is a way to set firmer boundaries without “ending it” with him — the fear of you cutting him off may be driving some of this behavior as well.

The first step I would recommend for anyone in a situation like this is to sit down and write out a schedule that would work and feel safe for you in terms of communicating with your father. Putting aside his demands and needs, if it were up to you, how often would you want to check in with him on the phone? How often would you want to see him? Would you want any contact at all with him after the way he’s treated you?

Once you have a better idea of what your needs are in the relationship (and have decided whether you want to have a relationship with him at all), it may be helpful for the two of you to sit down with a neutral third party (such as a licensed psychologist or licensed therapist) to find ways to communicate these boundaries with him in a way he can hear. It can be helpful to start with something like “Dad, I love you and want you to be part of our lives, but I have my own family that I have to put first sometimes. Can we find a way to meet someplace in the middle?” Another approach might be just to begin ignoring his calls and bids, and answering or agreeing to them only when you have the time and energy for them (and for him). You have every right to set limits on your own time and energy: they belong to you. If he yells and screams, you have the right to calmly leave or hang up the phone. In this approach, it is important for you to make a conscious effort to reach out to him — especially when you are both in a calm, neutral state. Trying to make changes when flooded with anger or frustration will only escalate the problems that already exist between you.

It can be very difficult to set boundaries with parents, or with others in our lives who pull for us to pay attention to them. Your anger toward your father is valid; it’s finding a way to effectively communicate that anger and set your own boundaries that is difficult. Talking to a licensed mental health provider may be most helpful for you given the pain you’ve experienced. I would also suggest reading Harriet Lerner’s Dance of Anger [Amazon-US | Amazon-UK] as another resource in figuring out how to express your feelings clearly while navigating this difficult relationship.

Reader’s Question

I am going through a hard breakup. I just wanted to know if there’s anyone out there who can help me out with tips or suggestions about moving on.

Psychologist’s Reply

One of the uncomfortable truths about relationships is that they at some point come to an end — sometimes by our own choice and sometimes by ways totally out of our control. Regardless, the loss of someone we care for can cause intimacy trauma unless we can find ways to cope and eventually recover. Over the years, if we have struggled with intimacy trauma repeatedly, we can find these emotions hanging around and reemerging in our new relationships.

One of the ways to limit the amount of intimacy trauma we experience is to begin to really listen to the conversation we are having with ourselves after a breakup or divorce. We need to listen to what we are telling ourselves about the loss. Here are some of the common conversations that my clients have with themselves that begin after a breakup.

I can’t live without them! I have to have them in my life.

These are some of the most common thoughts we have immediately after a breakup that lead to feelings of desperation and panic. Those we love and care about become very important parts of our lives. But we need to remember that no matter how close the person was to you, there was a time in your life when this person was not around. There was a time before you met them. You survived without them long enough to eventually meet them, right? The conversation with yourself needs to involve on some level you telling yourself you can be alright without them. There is meaning for your life outside your relationship, maybe you just lost sight of it along the way.

I’ll do whatever it takes to get them back.

I hear this a lot. The fear of being on our own or the need to avoid the loss we are experiencing can be enough to send us into a tailspin of anxiety and desperation. The absolute truth is that we can’t recover from the loss of a relationship until we accept that the loss has happened. Allowing yourself to accept the truth about what has happened can be one of the toughest things to do. You can stay in denial, bargain, plead for forgiveness, and promise that things will be different, but until you accept the reality of the situation, you cannot begin to recover. I know it sounds cruel, but having hope that you will get back together will only delay your recovery. Letting that go and giving into the recovery can be very hard.

Who will ever want me?

Being dumped or losing a relationship can easily bring on feelings of self-doubt and self-blame. We can easily convince ourselves that one rejection will lead to another and another and finally to the end result of being alone for the rest of eternity. The truth is, being rejected or turned away hurts. It’s tempting to come to a conclusion, in that conversation with yourself, that there is something wrong with you. Almost all of the breakups I’ve seen have been two way streets. By that I mean it is rarely just one person’s fault or mistake. Being in a relationship means that both people have to provide a healthy environment for the relationship to exist. If one or both people cannot do this, the relationship is unlikely to survive — and maybe even shouldn’t. Your conversation with yourself needs to take ownership for your part of the breakup, but recognize too that it is not all your fault. It takes two people to start a relationship and it takes two people to bring it to an end.

I can’t be alone.

Jumping into a new relationship after a devastating breakup is typically a bad answer to the way you’re feeling. Often we do this to avoid those feelings of loneliness. We think that if we can preoccupy ourselves with a new interest it will rescue us from difficult feelings. The truth here is that now you are dealing with the stress of a new relationship and grieving the old one at the same time. That can really make a mess of what could actually have been the right relationship for you. We need time to grieve our losses. Everyone’s amount of time is different, but many of us convince ourselves we are ready to start a new one when we are not. The conversation with yourself needs to address where you are emotionally in your recovery. Are you still thinking about the pervious person daily? Are you afraid and lonely still? Have you grown enough to bring a healthy place for the next relationship to survive in?

For anyone experiencing a breakup, you can start having this conversation with yourself today. Talk it through out loud if you need to. Give yourself the room and time to start your recovery process. A journal can help you see your progress if needed. Support groups for loss and grief are out there as well. If these feelings totally overwhelm you, which they can, seek help from a therapist.

Reader’s Question

I don’t know what’s wrong with me. I envy the people who enjoy food because I can never find such pleasure in eating. I find myself uninterested in most things. I don’t often feel sad or down, I just feel empty and unmotivated, and if I ever feel motivated to do something, it fades away in an instant. I used to enjoy going to the gym, and it used to feel great. That was five years ago. Now I can hardly get myself to a workout. Whenever I sit with friends or with new people I don’t feel happy about being around them; I don’t get that happy feeling or any feelings of satisfaction. I love math, physics and computer science, but when I find myself engaged in such activities I just can’t get myself focused on them because I find that I there’s no pleasure in doing the things I love the most. I don’t get any feelings of satisfaction or feel any relief. Every month, it hits me once or twice, lasting from days to weeks; I get this overwhelming feeling of emptiness. Sometimes I don’t even bother eating or drinking because I find no purpose in it. This doesn’t seem like depression. Is that possible?

Psychologist’s Reply

Much of what you describe is actually a major component of depression called anhedonia. Anhedonia is simply the inability to experience pleasure from activities normally found enjoyable or fun. Often it may come in the form of loss of the motivation to do the things you like to do or a lack of pleasure in those activities you normally enjoy, often called avolition. Many of my clients experience anhedonia as a significant part of their depression, sometimes even more intensely than just feeling depressed or blue. Many report it as chronic feelings of emptiness, not from boredom, but from feelings of hopelessness, feeling lonely or isolated. Most commonly I see anhedonia contribute to lower sex drive and being less social.

Although anhedonia is most commonly associated with depression, it can be present in schizophrenia, anxiety and personality disorders, albeit less frequently. Some researchers suggest that depression may shut down the brain’s pleasure center, making it difficult to feel good, basically limiting the amount of pleasure we can get from something. Others have suggested that anhedonia limits the amount of time we can feel good so that even if we do experience pleasure, it does not last long enough to matter.

Regardless of the cause, anhedonia is often very problematic and can derail recovery from depression by decreasing the desire to work, move forward and put effort towards recovery. Finding the energy to move forward can be difficult, especially when you don’t feel like doing it. However, it is needed to help in your recovery. Trying to keep up with as much of your normal routine as possible can make a huge difference. Anhedonia and depression can make us want to withdraw, stay in bed all day, and ignore relationships that we need, but fighting those urges can get you unstuck from the way you have been feeling. Sometimes it may just start with getting yourself out of bed. Then getting dressed. Then eating. Then beginning your next step. Take it in small increments to start out with. Coach yourself through each step before you begin to even think about the next. Simple exercise, even small amounts, has been found to help anhedonia significantly. Even small amounts of exercise will release chemicals in your brain that elevate mood and motivation. Taking a walk is a great way to get started. Get up, get moving. Medication is another option that benefits many. Fast acting antidepressants are being linked to restoring the brain’s ability to experience pleasure. Medication may come with some side effects, but the overall benefit often outweighs them.

One thing to be careful about is self-shaming or being self-critical about this. Many active and productive people experience anhedonia and tend to see it as a character flaw. They call themselves lazy, slow, pathetic, etc. I see this in those individuals who had extremely high levels of activity and production before the onset of their depression. We need to remember that this is a neurological and biochemical process in the brain. It is important for anyone in this situation to understand that it is your brain being impacted by the depression. It is not something you caused, and it is not a permanent change in who you are as a person. Criticizing yourself to get moving and go, shaming yourself, or “guilting” yourself to do better will likely only create a deeper depression. Adding low self-esteem to your depression is not going to help and will only prolong your trouble. To anyone in this position: go easy on yourself. Motivate with encouragement rather than shame and guilt. Recovery is a process. Allow yourself to be in that process without expectation about how long your recovery “should” take. In working with many people who are depressed, I have never seen anyone “yell and scream” at themselves back into feeling better. To anyone in this position, I would say: you can do this. You’ve got this.

Reader’s Question

I am a recent psychology graduate and a very close friend of mine is depressed, self-harming, and suicidal. I feel responsible for helping him but he keeps refusing, believing that nothing can help anymore. I used to think that it’s common for depressed people to refuse help so I should just try harder. We communicate on a daily basis but only via text. We never talk over the phone, we don’t meet often and sometimes even when we have made plans, he suddenly cancels, saying that he’s not in the mood. The bottom line is that, as the only person he confides in, keeping his trust is crucial. What should I do? Should I try to help him with another approach or should I just give him some space?

Psychologist’s Reply

Having someone close to you who is struggling with suicidal thoughts and depression can often make you feel helpless and powerless. However, you have already made the first step in helping and making a difference: you’ve noticed. Sometimes just noticing and showing concern can be very powerful and impactful. Many people know someone who struggles with depression and some even know a person close to them who has attempted or completed suicide. Over 30,000 Americans die by suicide each year and around 800,000 attempt suicide. It’s a very common problem, yet the stigma around it prevents us from doing what we really need to do to help — talk about it.

Talking about suicide is one preventative measure that I have seen help many of my suicidal clients. However, I hear many people ask: “If I talk about it, won’t it just encourage it? Won’t it just give them the idea?” The answer is no, not really. Talking about the emotional content around suicide, like depression and hopelessness, can actually help the suicidal person relieve stress and feel connected to supportive people like you. It’s rarely a comfortable conversation, but don’t let that stop you. If you suspect someone is thinking about it, it’s OK to be direct. Walking around the topic or beating around the bush can send the message that it’s not OK to talk about it. You can simply say something like “With the pain you’re in, I was wondering if you might have thought about hurting yourself?” If the answer is a “yes” you may want to see if they have thought about specific ways or plans on how they would do it. People who have seriously contemplated suicide might have gone ahead and made plans or taken action towards hurting themselves. Working with them to limit their access to their plans, like removing guns or stashes of pills is easier when you know that’s what they are planning to do. Ignoring it and just hoping it will go away isn’t the solution. Don’t let the comfortableness or the difficulty stop you from asking. Asking is good because it shows you’ve noticed.

Importantly, friends should never agree to secrecy about suicidal thoughts. Secrecy prevents people from talking about it. It’s alright to discuss with them about who to talk to and who not to talk to. Some people may not be very supportive and talking to them can actually make someone feel more alone and depressed. However, we need to keep them talking and keeping it a secret only prevents that.

You’d be surprised at how often people are willing to talk about it. Most suicidal individuals are looking for relief and escape from their pain, not for an end to their life. Talking about it can bring that relief. Once you can get them talking it may be easier than you think to keep the conversation going.

The next thing to help is really pretty easy: just be quiet and listen. Most of my suicidal clients report they often feel better for a bit when they feel like they have been heard. Don’t think you have to fix or solve their problems. A lot of people already know what they need to do to feel better. They just need support and encouragement to do it. Depression often inhibits their motivation to get to their solutions. Your support and hope can be enough to get them going toward recovery.

Where you can be more directive in helping is getting the suicidal person to the help they need. Assisting them in finding resources such as suicide crisis lines, therapy, psychiatrists and hospitals can be the next vital step.

One source is the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), which is free, confidential and available 24/7. There are even online crisis centers and crisis intervention through Skype or texting if talking to someone is too uncomfortable.

Please read my article on Myths About Suicide if you would like to learn more about suicide and those thinking about it.

Reader’s Question

Is it normal to still be painfully shy at almost 40? I have very few friends and live with my two kids. At work many of my colleagues have very little to do with me, and I tend to keep to myself a lot, as I get really nervous when I’m around too many of them at once. I avoid meetings and social gatherings in general since I sometimes just don’t know how to make small talk (which I also find to be a waste of time anyway). I’m also a bit boring, as I have no social life, and I’m also aware that I generally look very nervous, awkward and stupid. I sometimes get very depressed and anxious on Sunday afternoons as I know that on Monday it’s back to work again.

I would also like to meet someone new and start a relationship, but I have no idea how to go about doing it. I feel like I’m emotionally underdeveloped; I think I act like a school girl. I also feel very inferior to my peers who have well-adjusted families and active social lives. I often wish that I could be more like them. I feel really lonely sometimes. I just don’t know what to do with myself at this point in my life, and I feel myself becoming more and more reclusive and depressed. I know that I need to get out and interact with people, but I don’t know how/where to start and how to do it without appearing fake and nervous and stupid. I simply don’t know what to do.

Psychologist’s Reply

To answer your first question, yes, shyness is a common personality trait and is normal, no matter what age. In some cultures, shyness is seen as a positive trait — but because Western culture is very outgoing, it can be difficult to feel as if others experience shyness as well. It’s also very normal to want to have one or two close friends, or to have deeper conversation with one person rather than making small talk with acquaintances. Some individuals find it helpful to know that others are like this, and that a construct called Introversion (from the Myers-Briggs Type Indicator, MBTI) exists. Individuals who score higher on the Introversion (rather than Extraversion) end of the scale often feel drained if they have to interact with many people or make small talk — they tend to get their energy from their own thoughts and ideas and can become easily overwhelmed at parties or other large social gatherings. Some introverted individuals are also very sensitive, and find support in books such as The Highly Sensitive Person [Amazon-US | Amazon-UK] by Elaine Aron, PhD.

From what you’ve described, it sounds like you have some successful relationships — having had two children, having some friends, and being able to work in an office environment. You were able to form those relationships before, and I wonder whether anything may have changed in your life since then.

I can understand how difficult it can feel when the dread and fear set in when approaching situations that create worry and nervousness. If the worry is significantly interfering with your social, work, and other important areas, then it may be helpful to find a licensed mental health professional to rule out Social Anxiety Disorder and to help with increasing your relaxation response in social situations. They can also help explore the thoughts that are creating more worry (such as “I look nervous, awkward and stupid”) and the ideas that follow (which, for example, might be, “no one wants to be friends with me,” “others are just being nice to me because they have to be,” or “everyone’s looking at me and judging me”). A psychologist or other licensed mental health professional can help to better sort through these thoughts and feelings and help you find ways to reach your goals for connection with others.