Misdiagnosed with Depression? It Could Be Bipolar Disorder

Amen Clinics
June 25, 2025

Many with bipolar disorder are misdiagnosed with depression. Learn key symptoms and how a brain scan can help get the right treatment.

What’s worse than getting diagnosed a mental health condition? Being misdiagnosed with the wrong one. Some mental health conditions look and feel so much alike, it’s difficult even for professional clinicians to tell them apart.

That’s certainly the case for bipolar disorder (BD) and major depressive disorder (MDD). As many as 60% of people with bipolar disorder who visit psychiatry clinics are mistakenly diagnosed with depression, research has found.

Unfortunately, bipolar disorder misdiagnosis too often leads to inappropriate treatments, increased risk of worsening of symptoms, and delay in getting the right care. Early and accurate diagnosis of BD is critical for initiating successful treatment and attaining better outcomes.

Here, you’ll learn about the key differences in symptoms between the two disorders, as well as an innovative tool called brain SPECT imaging, which greatly increases the likelihood of getting an accurate diagnosis, the right treatment, and a better outcome.

The good news is that with the correct diagnosis and treatment, people with bipolar disorder or depressive disorder do get better.

Up to 60% of patients with bipolar disorder who visit psychiatry clinics are mistakenly diagnosed with depression.

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JENNA’S STORY: WHEN ANTIDEPRESSANTS BACKFIRE

Let’s take a look at a real-world example. Jenna is a college athlete whose depression diagnosis masked bipolar disorder.

As a college freshman, Jenna was a competitive track and field athlete who loved spending her days in her running shoes. By the time she reached her sophomore year, however, things had changed. She was filled with sadness, felt like she had no energy, and had lost interest in training.

When she mentioned it to her primary care doctor, she was diagnosed with depression and given a prescription for antidepressants.

The medication boosted her mood—a lot! She felt like she was on top of the world. It filled her with so much energy, she felt invincible and began training all day and staying up all night doing her homework.

She also became sexually aggressive, hitting on the other track athletes even though she had a steady boyfriend. She even came on to her coach multiple times, which didn’t go over well and ended up with her almost getting kicked off the team.

What went wrong?

WHY BIPOLAR DISORDER IS SO OFTEN MISDIAGNOSED AS DEPRESSION

Jenna had been misdiagnosed with depression. In reality, she had a form of bipolar disorder, formerly known as manic-depressive disorder. People with bipolar disorder display dramatic swings in mood, energy, and activity levels, going from depressive episodes to manic episodes in a cyclical pattern.

The antidepressants Jenna took not only failed to work, but they were also making her worse by triggering a manic episode.

Jenna’s misdiagnosis and experience is not unique. In a study analysis on bipolar disorder misdiagnosis, researchers noted that BD gets mistaken as depression because it typically starts with a depressive episode, and a patient is diagnosed before a manic or hypomanic episode occurs.

Additionally, research has found that bipolar disorder in women tends to manifest with more depressive episodes, which may increase their risk of being misdiagnosed with depression.

Another reason why bipolar disorder misdiagnosis occurs has to do with how mania appears in the patient.

Bipolar disorder’s manic episodes are characterized by:

Abnormally elevated mood
Inflated self-esteem
Decreased need for sleep
Increase in goal-oriented activity
Grandiose notions, ideas, or plans
Increased talking or pressured speech
Racing thoughts
Inability to “turn off the mind”
Poor-judgment leading to increased risk-taking behavior
Hypersexuality or hyper-religiosity
Excessive appetite
Inappropriate social behavior
Irritability or aggression
Delusions or hallucinations

When mania symptoms are mild and less severe, it’s called hypomania. An individual who has hypomanic episodes may feel like they have better energy than usual and a brighter mood but not so much that they engage in risky behavior.

When asked about mania in a clinical setting, they may not perceive these periods of improved mood and energy as manic.

Press Play to Learn the Early Signs of Bipolar Disorder

In this video, Amen Clinics psychiatrist Dr. Jay Faber discusses mood swings, sleep changes, and energy levels that might indicate bipolar disorder.

Click below to tune in.

WHAT DEPRESSION AND BIPOLAR HAVE IN COMMON

While they are distinct disorders, depression and bipolar disorder are both mood disorders and have depressive symptoms in common.

Let’s look at depression vs bipolar disorder.

Depression

Depression is characterized by persistent feelings of sadness, hopelessness, and loss of interest or pleasure in activities. It can significantly impact a person’s daily life, affecting their feelings, thoughts, behaviors, and physical well-being.

It’s more common than BD. An estimated 21 million adults in the US had at least one major depressive episode—about 8.3% of all adults, according to recent data. It is more common in females.

Bipolar Disorder

On the other hand, bipolar disorder (also called manic depression) is characterized by pronounced shifts in mood, energy, and activity levels—just what Jenna experienced.

An individual with BD cycles through these moods, which vary from periods of intense highs (mania or hypomania) to dark lows (depression).

These highs and lows are much more intense than the typical ups and downs of life that we all experience. An estimated 2.8% of U.S. adults had bipolar disorder in the past year, data indicates. About 82% of people with BD are seriously impaired, and 17.1% are moderately impaired.

Depression and Bipolar Disorder: Shared Symptoms

A depressed person and an individual with bipolar disorder in a depressive episode will exhibit depressed symptoms, which may include any number of the following:

Persistent low or sad mood
Sleeplessness
Feelings of guilt
Decreased energy levels
Difficulty maintaining concentration
Decreased or changes in appetite
No longer find pleasure in activities once enjoyed (anhedonia)
Increased or decreased psychomotor activity
Recurrent suicidal ideation/acts of self-harm/suicide attempt

Thus, if you have bipolar disorder and are experiencing a depressive episode, it may look just like depression.

As we saw with Jenna, when a person with bipolar disorder gets misdiagnosed with depression, they will typically be treated with antidepressants. However, antidepressants and bipolar disorder are not good together. Without mood stabilizers, they are linked to poor outcomes for BD patients, in most cases.

A misdiagnosis of depression and antidepressant treatment will increase the risk of manic episodes in approximately 30% to 40% of people with bipolar disorder, studies have found. This was proven to be true in Jenna’s case.

MANIC AND HYPOMANIC SYMPTOMS THAT SET BIPOLAR APART

Because manic and hypomanic symptoms are not characteristic of major depressive disorder, they offer one of the best ways to discern BD from depression. The problem is, as mentioned, hypomania can be challenging to identify.

Hypomania and mania both involve episodes of increased energy and elevated mood, but they are very different in severity and the impact they make on one’s daily life.

Let’s take a closer look at hypomania vs mania.

Hypomania

Hypomania may involve many of the manic symptoms listed above, with a couple of exceptions. Typically, the symptoms appear in a milder form than mania.

It does not involve psychosis and only minimal disruption to one’s daily functioning, if there’s any disruption at all. It typically does not require hospitalization. Experts say that a good measure is a noticeably different mood than usual.

Mania

Mania is a highly disruptive, intense experience that often requires hospitalization and may involve psychosis. The elevated mood can also come with irritability and its increased energy is often coupled with lots of activity.

Mania typically lasts at least one week but can continue for several months, and even up to a year, if left untreated.

Although mania and hypomania symptoms offer valid biomarkers to distinguish BD from depression, research reports that there’s not enough information available to clinicians about the harder-to-detect hypomania symptoms.

Studies have also found that bipolar disorder patients typically lack insight about their own mania or hypomania symptoms. This adds to the issue of misdiagnosis, delayed diagnosis, and poor outcomes.

THE DANGERS OF THE WRONG TREATMENT

When a person with bipolar disorder is misdiagnosed with depression, it can be downright dangerous. Antidepressants may work well for depression, but antidepressants and bipolar disorder can be a bad combination.

For example, they can trigger manic episodes, worsen instability, and delay effective treatment. Research indicates that people with BD who take antidepressants are believed to have an increased risk of rapid cycling.

Rapid cycling is when an individual with BD has at least four episodes of affective illness in one year, with two months of full or partial remission in between, or a switch to the opposite pole. In some cases, rapid cycling is associated with greater resistance to treatment and worse outcomes.

Currently, treatment guidelines recommend bipolar disorder patients take antidepressants together with a mood stabilizer. However, when the wrong treatment delays successful bipolar disorder management with mood stabilizers, it may increase the risk of lithium resistance. This is known to occur as a person has more episodes.

Appropriate treatment is critical for those with bipolar disorder as it can reduce suicide risk. And when it is caught early in children and adolescents, it can reduce the risk of substance abuse as they grow older.

Accurate and early diagnosis can make a marked difference in outcomes for those struggling with this mental health disorder.

UNDERSTANDING THE FOUR TYPES OF BIPOLAR DISORDER

Like so many mental health conditions, bipolar disorder is not a simple or single condition. It manifests in different ways.

Mental health experts have identified at least four types of bipolar disorder.

The types are distinguished by the severity of the symptoms (yet all four types are equally serious):

Bipolar 1 disorder (also called bipolar I disorder) is considered the most severe form of the condition.
Bipolar 2 disorder (also called bipolar II disorder) has hypomania symptoms that are frequently misdiagnosed, according to a special 2023 report. Bipolar 2 symptoms are more common in women, research has found, and it is the type of bipolar disorder Jenna had.
Cyclothymic disorder exhibits the presence of numerous periods of hypomanic and depressive symptoms for at least two years in adults (one year in children and adolescents).
Bipolar disorder not otherwise specified is a catch-all subtype used when symptoms don’t fall into established patterns. It’s typically given when an individual experiences mood fluctuations (mania and depression) characteristic of BD, but don’t exactly meet the diagnostic criteria for one of the other bipolar diagnoses.

The good news is that bipolar disorder responds well to proper treatment, but knowing an individual’s type is essential for developing the right medication and therapeutic approach.

THE TURNING POINT: GETTING A BRAIN-BASED DIAGNOSIS

The turning point for Jenna was when she decided to visit Amen Clinics to get a brain scan to find out what was really happening in her brain.

Amen Clinic’s brain SPECT imaging, which measures blood flow and activity in the brain, can reveal differences in brain activity patterns between individuals with bipolar disorder and those with clinical depression.

Jenna’s SPECT scan for bipolar disorder, along with a complete personal history and other assessments, pointed to bipolar 2 disorder. Knowing her condition type helped develop a treatment plan personalized for her needs.

With the proper treatment and good compliance, Jenna’s moods stabilized, and she eventually became a successful and well-liked track and field coach at her alma mater.

WHY SEEING THE BRAIN CHANGES EVERYTHING

For many patients, visualizing their brain scan helps them accept their diagnosis, stay compliant with treatment, and feel empowered to heal.

In Jenna’s case, seeing her brain scan helped her understand that her condition was real, so it encouraged her to take her medication regularly. Compliance is a problem for many people with bipolar disorder because when they start to feel better, they don’t believe they have a problem at all and often stop taking their medication.

For Jenna, as with many people, seeing was believing.

FAQ

How do I know if I’ve been misdiagnosed with depression instead of bipolar disorder?

At Amen Clinics, we see this often especially in young adults and women. If your depression treatment has made you feel wired, impulsive, or emotionally unstable, it may be time to take a deeper look.

Can antidepressants make bipolar disorder worse?

Yes. In many cases, antidepressants can trigger manic or hypomanic episodes in people with undiagnosed bipolar disorder. That’s why proper diagnosis is so critical before beginning treatment for bipolar disorder.

How does Amen Clinics diagnose bipolar disorder differently?

We combine brain SPECT imaging with an in-depth evaluation of your biological, psychological, social, and spiritual history. This approach helps us identify the right diagnosis and tailor treatment to your brain type.

Mood disorders, such as depression or bipolar disorder, and other mental health conditions can’t wait. At Amen Clinics, we provide personalized, science-backed treatment plans designed to target the root causes of your symptoms. Our 360-approach includes brain SPECT imaging, clinical evaluations, innovative therapeutic techniques, medications (when necessary), and holistic lifestyle recommendations to promote the health of your brain, body, and mind. Speak to a specialist today at 888-288-9834 or visit our contact page here.

Amen Clinics

Founded in 1989 by double-board certified psychiatrist and neuroscientist Daniel G. Amen, MD, Amen Clinics Inc. (ACI) is known as the best brain and mental health company in the world. Our clinical staff includes over 50 healthcare specialists, including adult and child psychiatrists, integrative (functional) medicine physicians, naturopaths, addiction specialists, forensic psychiatrists, geriatric psychiatrists, nutritionists, licensed therapists, and more. Our clinicians have all been hand-selected and personally trained by Dr. Amen, whose mission is to end mental illness by creating a revolution in brain health. Over the last 35-plus years, ACI has built the world’s largest database of functional brain scans—over 250,000 SPECT scans on patients from 155 countries—related to how people think, feel, and behave.

REFERENCES

Wu, Z., Wang, J., Zhang, C. et al. Clinical distinctions in symptomatology and psychiatric comorbidities between misdiagnosed bipolar I and bipolar II disorder versus major depressive disorder. BMC Psychiatry 24, 352 (2024).

Hui Shen, Li Zhang, Chuchen Xu, Jinling Zhu, Meijuan Chen, Yiru Fang – Analysis of Misdiagnosis of Bipolar Disorder in An Outpatient Setting: Shanghai Archives of Psychiatry 2018;30(2):93-101.

Parial S. Bipolar disorder in women. Indian J Psychiatry. 2015 Jul;57(Suppl 2):S252-63.

National Institute of Mental Health, https://www.nimh.nih.gov/health/statistics/major-depression, Accessed June 20, 2025

National Institute of Mental Health, https://www.nimh.nih.gov/health/statistics/bipolar-disorder, Accessed June 20, 2025

Glick ID. Undiagnosed Bipolar Disorder: New Syndromes and New Treatments. Prim Care Companion J Clin Psychiatry. 2004;6(1):27-33.

Vöhringer PA, Perlis RH. Discriminating Between Bipolar Disorder and Major Depressive Disorder. Psychiatr Clin North Am. 2016 Mar;39(1):1-10.

Hui Shen, Li Zhang, Chuchen Xu, Jinling Zhu, Meijuan Chen, Yiru Fang – Analysis of Misdiagnosis of Bipolar Disorder in An Outpatient Setting: Shanghai Archives of Psychiatry 2018;30(2):93-101.

Glick ID. Undiagnosed Bipolar Disorder: New Syndromes and New Treatments. Prim Care Companion J Clin Psychiatry. 2004;6(1):27-33.

Suppes, T., Swartz, H. A., & Schley, S. (2023). Special Report: Bipolar Disorder II—Frequently Neglected, Misdiagnosed. Psychiatric News, 58(03).

Why You’re Feeling Angry Lately—and How to Cool Down

Amen Clinics
June 18, 2025

Chronic anger harms your brain and mental health. Learn what brain scans reveal and find six anger management tools to help you cool off.

Feeling angry these days? Join the club. Nearly 90%of Americans say a recent political issue or news story has triggered their anger, according to the latest Mood of the Nation Poll. And 46% of them said it made them “extremely angry.”

There’s a lot to be upset about—divisive politics, economic stress, social unrest, ongoing global conflict, rising mental health struggles, and even the relentless negativity in the news cycle. These are just some of the causes of increased anger.

Social media fans the flames, feeding us a constant stream of outrage-inducing content. It’s no wonder so many people feel like they’re at a breaking point.

But here’s the problem: chronic anger doesn’t just make life more stressful—it actually harms your brain. When anger simmers or explodes regularly, it can lead to serious consequences for your mental health, physical well-being, and relationships.

In this blog, you’ll discover what anger does to your brain, why anger management is essential for your emotional and cognitive health, and practical strategies to help you cool down and regain control.

Chronic anger doesn’t just make life more stressful—it actually harms your brain and can lead to serious consequences for your mental health, physical well-being, and relationships.

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THE RISKS OF UNRESTRAINED ANGER

Uncontrolled anger is detrimental in so many ways, negatively affecting relationships, physical health, and mental well-being.

Ruinous for relationships: Having a short temper harms romantic connections, family dynamics, friendships, and work relationships.
Higher risk of heart disease: A study in the journal Circulation found that people who are prone to anger have twice the risk of coronary heart disease than those who aren’t as angry.
Increased risk of stroke: People are at three times the risk of having a stroke in the two hours following an angry outburst, based on research.
Weakened immune system function: Anger also dampens the immune system, according to a study from Spanish scientists.
Decreased lung function: Higher levels of hostility are associated with greater declines in lung function, according to research.
Increased anxiety: Anger can worsen generalized anxiety disorder, based on findings from a study in Cognitive Behavior Therapy.
Linked to other mental health issues: Anger is also recognized as a symptom that is associated with several other mental health conditions, including clinical depression, ADHD, personality disorders, and substance abuse.

THE NEUROBIOLOGY OF ANGER: UNDERSTANDING THE BRAIN’S ROLE IN AGGRESSIVE BEHAVIOR

Anger is a complex emotion that involves various regions of the brain, each contributing to how we experience and express this powerful feeling. Understanding the neurobiological underpinnings of anger can provide valuable insights into managing and mitigating its effects.

Neurotransmitters and Hormones Influencing Anger

Serotonin: Low levels of serotonin have been linked to increased aggression and impulsivity. This neurotransmitter helps regulate mood, and its deficiency can impair the ability to control emotional responses.
Testosterone: Higher levels of testosterone have been associated with aggressive behavior. This hormone influences areas of the brain involved in regulating emotions and social behaviors.
Cortisol: Known as the stress hormone, cortisol’s interaction with other hormones and neurotransmitters can affect aggression levels. Chronic stress leading to elevated cortisol may contribute to heightened anger responses.

Understanding the Brain’s Anger Circuitry

The interplay between these brain regions and chemicals forms a network that governs our experience of anger:

Threat Detection: The amygdala rapidly assesses sensory information for potential threats, initiating an immediate emotional response.
Response Coordination: The hypothalamus activates the autonomic nervous system, leading to physiological changes that prepare the body for action.
Behavioral Regulation: The prefrontal cortex evaluates the appropriateness of the anger response, applying brakes when necessary to prevent undesirable actions.
Execution of Response: The periaqueductal gray integrates signals from the amygdala and hypothalamus to produce defensive behaviors.

Having explored the neurobiological foundations of anger, it’s essential to recognize how these internal mechanisms interact with external factors, such as environmental stressors and personal experiences, in shaping our emotional responses.

WHAT BRAIN SCANS REVEAL ABOUT ANGER AND AGGRESSION

Anger issues can be a sign of trouble in the brain. In a study in the Annals of Clinical Psychiatry, the research team at Amen Clinics performed brain SPECT imaging studies on 40 individuals who had physically attacked another person or destroyed property as well as on 40 non-aggressive people as controls.

The SPECT scans of the people with aggressive behavior showed significant differences from the control group in several brain regions. These included:

Decreased activity in the prefrontal cortex. Low activity in this area is associated with poor impulse control.
Increased activity in the basal ganglia and limbic system. These patterns are often seen in people with anxiety and depression.
Temporal lobes abnormalities. More than 70% of the aggressive people had abnormalities in the left temporal lobe region of the brain. The temporal lobes are involved in mood stability, memory, and learning.

Dysfunction here is associated with irritability, anger, and violent thoughts. Common causes of temporal lobe problems include genetics, head injuries, and exposure to toxins or infections.

6 ANGER MANAGEMENT STRATEGIES

The good news is you can control temper flare-ups even in the worst situations. The following six steps have proven to be helpful for many Amen Clinics patients.

Know and focus on your goals. If you want to have a kind, caring, loving relationship with your spouse or children, write it down on a piece of paper and look at it every day. Then always ask yourself, “Does my behavior get me what I want?”
Keep track of when you get angry. Write them down and learn as much about those times as possible. Know your vulnerable times, so you can learn from them and avoid them in the future.
5 x 2 = 10. Whenever you start to react in an angry or irritated way, get control of your breathing. Even before we are consciously aware of being upset, our breathing starts to become faster and shallower, making it more likely we’ll lose control of our behavior. Whenever you start feeling irritated, take a deep breath (5 seconds in, hold it for 2 seconds, then slowly breathe out for 5 seconds). Repeat that pattern 10 times. This will give you plenty of oxygen for your brain to make a thoughtful decision.

Press Play to Learn More About How to Calm Anger

In this video, Dr. Daniel Amen reveals why some people have what he call the Angry Dragon, one of the mental “dragons” that are constantly breathing fire on the emotional centers of the brain. Find out if you have this dragon, what causes it, what triggers it, and how to tame it.

Click below to tune in:

Video: 8 Ways to Soothe Anger

Make a list. Write and keep handy a list of 10 things you can do when you get upset in order to distract yourself. Distraction is a powerful anger management technique. Common distractions include taking a walk, calling a friend, saying a prayer, and doing a simple meditation.
Play it out. Ask yourself: if you react in an angry way to the situation at hand, what will happen to your relationships, to your goals, to those you love? Think about immediate and long-term effects. Forethought is a strength of the human brain. Use it to keep yours under control.
Seek help. If you’re having trouble controlling your anger, and it’s causing significant problems in your relationships or in your career, it’s time to get professional help. It’s worth investigating if underlying brain dysfunction is contributing to feelings of rage or anger related to mental health conditions.

THE BOTTOM LINE ON ANGER AND YOUR BRAIN

Anger may feel justified in the moment, but when it lingers or erupts uncontrollably, it can damage your brain, your body, and your life. Understanding the neurobiology of anger—and seeing how it shows up on brain scans—proves that this emotion is more than just a fleeting feeling. It’s a brain health issue that deserves your attention.

The good news is, you don’t have to stay stuck in a cycle of rage or regret. With the right tools and support, you can learn to manage your anger, protect your brain, and build healthier relationships. Your brain can change—and when it does, your life can, too.

Anger, depression, ADHD, and other mental health issues can’t wait. At Amen Clinics, we provide personalized, science-backed treatment plans designed to target the root causes of your symptoms. Our 360-approach includes brain SPECT imaging, clinical evaluations, innovative therapeutic techniques, medications (when necessary), and holistic lifestyle recommendations to promote the health of your brain, body, and mind. Speak to a specialist today at 888-288-9834 or visit our contact page here.

Amen Clinics

REFERENCES

Helmstetter C, et al. Mood of the Nation: Angry. APM Research Lab, April 23, 2024. https://www.apmresearchlab.org/motn/what-makes-americans-angry-proud

Williams JE, et al. Anger Proneness Predicts Coronary Heart Disease Risk : Prospective Analysis From the Atherosclerosis Risk In Communities (ARIC) Study. Circulation. Volume 101, Number 17. https://doi.org/10.1161/01.CIR.101.17.2034

Mostofsky, Elizabeth et al. “Outbursts of anger as a trigger of acute cardiovascular events: a systematic review and meta-analysis.” European heart journal vol. 35,21 (2014): 1404-10. doi:10.1093/eurheartj/ehu033

Romero-Martínez, A et al. “High Immunoglobulin A Levels Mediate the Association Between High Anger Expression and Low Somatic Symptoms in Intimate Partner Violence Perpetrators.” Journal of interpersonal violence vol. 31,4 (2016): 732-42. doi:10.1177/0886260514556107

Kubzansky, L D et al. “Angry breathing: A prospective study of hostility and lung function in the Normative Aging Study.” Thorax vol. 61,10 (2006): 863-8. doi:10.1136/thx.2005.050971

Deschenes SS, et al. The Role of Anger in Generalized Anxiety Disorder. Cognitive Behaviour Therapy. March 2012Cognitive Behaviour Therapy 41(3):261-71

DOI:10.1080/16506073.2012.666564

Amen, D. G., Stubblefield, M., Carmichael, B., & Thisted, R. (1996). Brain SPECT Findings and Aggressiveness. Annals of Clinical Psychiatry, 8(3), 129–137. https://doi.org/10.3109/10401239609147750

Loving Someone with ADHD: 12 Common Relationship Challenges

Amen Clinics
June 11, 2025

Facebook-f X-twitter Youtube Falling in love with someone with ADHD can be easy. People with this common mental health condition are often intelligent, passionate, and

Falling in love with someone with ADHD can be easy. People with this common mental health condition are often intelligent, passionate, and spontaneous, which can make a relationship exciting. Living with these people, however, can pose some unique emotional and behavioral challenges that may lead to relationship problems and marital conflict.

At Amen Clinics, the global leader in brain health, our neuropsychiatrists have worked with thousands of people with attention deficit hyperactivity disorder (ADHD)—also known as attention deficit disorder (ADD)—and their partners. Based on this experience, here are the 12 most common issues that arise in these relationships and some simple strategies to help partners of people with ADD cope more effectively.

Falling in love with someone with ADHD can be easy. Living with them, however, can pose some unique emotional and behavioral challenges that may lead to relationship problems and marital conflict.

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THE EXCITING AND CHALLENGING SIDES OF ADHD IN RELATIONSHIPS

People with ADHD can be incredibly creative and high energy. Decades of clinical practice at Amen Clinics working with individuals who have ADHD have shown that they can be:

Highly Intelligent: Comedic genius Ellen DeGeneres, author Mel Robbins, and talk show host Trevor Noah are just a few brilliant figures who have opened up about being diagnosed with ADHD.
Creative: They often make wonderful writers, artists, and salespeople.
Natural Risk Takers: Think entrepreneurs, CEOs, firefighters, ER physicians, and trauma nurses. While most people run away from dangerous situations, people with ADD tend to run towards them.

Thanks to these traits, life with someone who has the condition can be spontaneous, exciting, and unpredictable. But that same impulsivity and intensity can lead to conflict and misunderstanding.

The brain-imaging work at Amen Clinics using single photon emission computed tomography (SPECT) shows that people with this common condition often have abnormal activity in certain areas of the brain. single photon emission computed tomography (SPECT) is an advanced imaging technique that measures blood flow and activity in the brain.

SPECT scans reveal that ADHD is often associated with low blood flow and activity in the brain’s prefrontal cortex. The PFC is responsible for high-level brain functions such as decision-making, judgment, impulse control, and learning from one’s mistakes. Low blood flow here is linked to problems in these areas, which can have a negative impact on relationships.

For instance, research on marital relationships involving adults with ADHD indicated that they frequently held more negative perceptions of the relationship compared to their spouses, who reported higher levels of satisfaction.

12 COMMON ADHD RELATIONSHIP CHALLENGES

Let’s explore the most frequent issues couples face when one partner—or both—has ADHD and take a look at some of the consequences that can develop.

1. Speaking Without Thinking

Although a person has a thought, it doesn’t mean that it is accurate or that they even necessarily believe it. Statements like “that’s a stupid idea” can be damaging to hear in a relationship and result in hurting the person on the receiving end. Yet, many people with ADHD tend to blurt out whatever comes to mind without thinking about how it will affect their partner.

2. Misperceptions and Communication Breakdowns

Misperceptions often cause serious problems in relationships. Often the spouse of an ADHD person must spend an inordinate amount of time correcting misperceptions that lead to disagreements.

One Amen Clinics patient said that before he was leaving on a business trip, he told his wife that he was going to miss her. She heard his words as “I’m not going to miss you” and was angry at him for the rest of the night, no matter what he said.

Science backs this up. One study in the Journal of Attention Disorders found that people with ADHD have higher levels of interpersonal problems and troubles with family relationships.

3. Interruptions and Distractibility

Due to distractibility, conversations are often cut short or left uncompleted, leaving the other person feeling unimportant. People with ADHD need to have what they want right away, which often causes problems in situations where they need to take turns, such as in conversations.

Spouses often complain that they are cut off or interrupted, which makes them feel disrespected.

4. Chronic Procrastination and Disorganization

People with ADHD person often wait until the very last minute or are too disorganized to get things done such as paying the bills, buying holiday gifts, or making dinner reservations for anniversaries.

A study performed on people with ADHD showed that poor time management, low self-esteem, and worries may be associated with reduced interpersonal skills and difficulty maintaining relationships.

In addition, they may not complete chores even though they fully intended to do so. This may irritate spouses who feel the need to pick up the loose pieces or who feel unloved or unimportant.

5. Sensory Sensitivity

Some adults with ADHD are sensitive to touch, which can make them shy away from affection. This can harm a relationship, especially if the person’s partner wants or needs affection.

6. Excessive or Minimal Talking

Sometimes people with ADHD talk for self-stimulation. There is an internal drive to go on and on. This may irritate significant others, who feel like a prisoner of the conversation—or monologue—because they can’t get a word in edgewise.

In other cases, people who love someone with ADHD may complain that there is little talking or emotional expression in the relationship. “They seem turned off when they come home” is a common complaint, and many spouses report getting short responses, such as, “fine” or “OK.”

7. Risk-taking Behavior

This type of behavior worries the partners of the ADHD person. In some cases, spouses feel pressured to go along with dangerous or reckless behavior, causing a rift in the relationship.

8. Emotional Volatility and Mood Swings

Many spouses say that they never know what to expect from their ADHD partner. “One minute they’re happy, the next minute they’re screaming,” is a common complaint. Small amounts of stress may trigger huge explosions.

Problems with emotional regulation and ADD are common. Some studies have reported that approximately 70% of adults with ADHD struggle with emotional dysregulation. Rooted in an inability to manage emotional responses, emotional dysregulation can look like bursts of rage, crying, and temper.

After this occurs several times in a relationship, the partner can become “gun shy” and may begin to withdraw from the person. In some cases, untreated ADHD may be often involved in abusive relationships.

9. Drama-seeking

This is a common complaint among people living with someone who has ADHD. People with this condition often look for trouble as a way to self-stimulate. Rather than ignoring a minor incident, they focus on it and have difficulty letting it go.

Romantically, partners who have ADHD struggle in navigating conflict resolution and maintaining the relationship long term. Things in an ADHD house do not remain peaceful for long periods of time.

10. Restlessness and Escapism

Having ADHD can make a person feel restless or anxious, causing them to seek out ways to relax. They may use excessive sex, food, or alcohol to try to calm themselves.

One patient at Amen Clinics had sex with his girlfriend over 500 times in the last year of their relationship. She left him because she felt that their relationship was only based upon sex.

11. Difficulty Seeing Other’s Emotional Needs

Many people with ADHD have trouble getting outside of themselves to see the emotional needs of others. Studies have shown that adults with ADD tend to have lower levels of empathy.

This is theorized to stem from the difficulties tied to socializing skills, executive functioning, and emotional dysregulation. Spouses often label them as spoiled, immature, or self-centered.

12. Repeating The Same Arguments Without Resolution

People with ADHD often engage in repetitive, negative arguments with their partner. They don’t learn from the interpersonal mistakes from their past and repeat them again and again.

6 Survival Strategies for Partners of ADHD Individuals

Supporting a partner with ADHD is critical for your relationship, as well as for your loved ones’ physical and mental health. Research on people with ADHD over the age of 50 found that a lack of a support system negatively impacted quality of life. On the flip side, having a supportive spouse enhanced daily functioning and overall sense of well-being.

If you’re wondering how to support an ADHD partner, try the following expert tips. These ADHD survival strategies can help reduce conflict and improve emotional connection in relationships.

1. Be specific with requests.

Avoid vague requests. Clarity helps reduce misunderstandings. For example, when you ask your significant other to do something, make it clear. Instead of asking, “Can you rake the leaves?” try “Can you rake the leaves before lunchtime?”

2. Use reminders and technology tools.

Set up alerts, lists, and visual cues to help your partner stay on track. Perhaps you leave sticky notes around the house for them, download a shared calendar app, or set up check-in reminders to show your investment.

3. Adjust expectations.

Accept your partner’s strengths and limits with compassion, not frustration. This may involve building in extra time when making plans, asking them to sit down and connect if you’re feeling ignored, or even offering support if they are not meeting your expectations.

4. Set boundaries and enforce them gently.

Boundaries build safety. Remind often and reinforce without shaming. If your partner is raising their voice at you during a heated discussion, instead of adding fuel to the fire, you could say “I want to keep talking, but I need us to lower our voices. I won’t continue the conversation if we’re yelling.”

5. Encourage a brain-healthy lifestyle.

Exercise, nutrition, and supplements like omega-3 fatty acids and green tea can improve brain function. Suggesting healthy meal ideas, making plans with them that involve exercise, and having nutritious snacks available in the house can all help.

6. Understand their ADHD type.

Based on the brain-imaging work at Amen Clinics, there are seven types of ADHD:

Classic ADHD
Inattentive ADD
Overfocused ADD
Temporal Lobe ADD
Limbic ADD
Ring of Fire ADD
Anxious ADD

Knowing more about your partner’s ADHD type can increase understanding and help you come up with targeted solutions to reduce symptoms and improve relationships.

When natural solutions or traditional treatments aren’t working, a brain scan may be beneficial to identify their type and to see signs of other problems, such as traumatic brain injuries that can mimic or worsen ADHD symptoms.
Related: 7 Types of ADHD eBook

WHEN TO CONSIDER A BRAIN SCAN OR PROFESSIONAL HELP

If your partner has ADHD and marriage problems persist despite trying natural interventions and standard treatments, it may be time to seek help from a mental health professional. In some cases, a SPECT scan can offer insights into the underlying neurological patterns contributing to relationship conflict.

In marital partnerships, there are promises and investments made. While these deepen the relationship, they also invite larger expectations, greater responsibilities, and a constant collision of lifestyles.

To make sure that you are there for each other “in sickness and in health”, there are resources you can seek to support both you and your partner.

ADHD can be challenging not only for the person diagnosed, but also for their romantic partner. Each person in the relationship experiences unique obstacles and overcoming the relational complexities requires effort and vulnerability.

While these types of dynamics require more work, it’s this very investment in which healthy habits are more frequently practiced, and a deeper, more resilient union is formed.

FAQ

What are the biggest relationship challenges when your partner has ADHD?

Communication issues, emotional dysregulation, impulsivity, and forgetfulness are common relationship strains that often stem from untreated or mismanaged ADHD.

How can I support my partner without enabling their ADHD behaviors?

Support looks like structure, clear communication, and healthy boundaries, not rescuing or doing everything for them. Encourage brain-healthy routines and consistency.

Does understanding their ADHD type really make a difference?

Yes, there are seven types of ADHD, and each requires different strategies. A brain scan can uncover the specific type and lead to more effective solutions for both behavior and relationship success.

ADHD and other mental health conditions can’t wait. At Amen Clinics, we provide personalized, science-backed treatment plans designed to target the root causes of your symptoms. Our 360-approach includes brain SPECT imaging, clinical evaluations, innovative therapeutic techniques, medications (when necessary), and holistic lifestyle recommendations to promote the health of your brain, body, and mind. Speak to a specialist today at 888-288-9834 or visit our contact page here.

Amen Clinics

REFERENCES

Beheshti, A., Chavanon, ML. & Christiansen, H. Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis. BMC Psychiatry 20, 120 (2020). https://doi.org/10.1186/s12888-020-2442-7

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-2442-7

Groen, Y et al. “Reduced emotional empathy in adults with subclinical ADHD: evidence from the empathy and systemizing quotient.” Attention deficit and hyperactivity disorders vol. 10,2 (2018): 141-150. doi:10.1007/s12402-017-0236-7. https://pmc.ncbi.nlm.nih.gov/articles/PMC5973978/

Sodano, S. M., Tamulonis, J. P., Fabiano, G. A., Caserta, A. M., Hulme, K. F., Hulme, K. L., Stephan, G. R., & Tronci, F. (2019). Interpersonal Problems of Young Adults With and Without Attention-Deficit/Hyperactivity Disorder. Journal of Attention Disorders, 25(4), 562-571. https://doi.org/10.1177/1087054718821728 (Original work published 2021). https://journals.sagepub.com/doi/10.1177/1087054718821728

Ginapp, Callie M et al. “The experiences of adults with ADHD in interpersonal relationships and online communities: A qualitative study.” SSM. Qualitative research in health vol. 3 (2023): 100223. doi:10.1016/j.ssmqr.2023.100223

https://pubmed.ncbi.nlm.nih.gov/37539360/

Wymbs, Brian T et al. “Adult ADHD and romantic relationships: What we know and what we can do to help.” Journal of Marital and Family Therapy vol. 47,3 (2021): 664-681. doi:10.1111/jmft.12475

Nyström, A., Petersson, K., & Janlöv, A. C. (2020). Being Different but Striving to Seem Normal: The Lived Experiences of People Aged 50+ with ADHD. Issues in Mental Health Nursing, 41(6), 476–485. https://doi.org/10.1080/01612840.2019.1695029

Kwon, Soo Jin et al. “Difficulties faced by university students with self-reported symptoms of attention-deficit hyperactivity disorder: a qualitative study.” Child and adolescent psychiatry and mental health vol. 12 12. 1 Feb. 2018, doi:10.1186/s13034-018-0218-3

https://pmc.ncbi.nlm.nih.gov/articles/PMC5796579/

Quiz: Is Your Child’s Anger Out of Control?

Amen Clinics
June 9, 2025

Take our child anger quiz to find out if your child’s temper is typical—or a red flag for a deeper issue that needs attention.

Are there moments when your child yells at you in public, hits their sibling, or throws things across the room in frustration? You’re not alone, and it doesn’t mean you’re a bad parent. Studies show that it’s normal for children experience outbursts from time to time, which is part of their developmental journey.

That said, a child’s anger can sometimes become so intense that it begins to affect their daily life, relationships, and school performance. When aggressive behavior in kids becomes frequent and disruptive, it may signal something deeper than just a phase you can simply “wait out” as a parent.

Some outbursts may be early signs of behavioral problems that call for intervention and tailored child anger management strategies.

In this blog, we’ll explore potential underlying neurological or mental health conditions and offer practical approaches to help your child manage big emotions effectively. Plus, you’ll find a quiz to help you gauge if your child’s anger is a problem.

Anger in kids isn’t always just a phase. Sometimes, it’s a sign of something deeper—like ADHD, anxiety, or even a brain issue. Take the quiz to find out what your child’s temper might really mean.

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ANGER IN A CHILD’S BRAIN

Sometimes, child anger issues are not just about defiance or frustration. Intense or hard-to-manage anger could be rooted in the way a child’s brain functions. These brain differences may be linked to mental health conditions like:

Attention deficit hyperactivity disorder (ADHD)
Anxiety disorders
Obsessive-compulsive disorder (OCD)
Traumatic brain injury (TBI)
Temporal lobe abnormalities

Consider the story of Denise, a 13-year-old girl who once pulled a knife on her mother during a temper outburst. Upon realizing that this was beyond the usual teenage behavior, her parents decided to take her to Amen Clinics for mental health assessments for children to understand what could be causing her distress.

A brain-imaging scan using a technology called SPECT showed that Denise had abnormal activity in her left temporal lobe.

The temporal lobes of the brain are involved in mood stability, memory, and learning. Abnormal activity in this region is associated with aggression, dark or violent thoughts, and emotional instability. It’s also seen in reading difficulties.

Denise always had school problems, especially when reading, and that caused intense frustration. She would blame herself, thinking, “If I just try harder, I won’t be so stupid.”

But trying harder wasn’t the real issue. Her brain simply required support. Through a tailored treatment plan and educational therapy, her child anger problems subsided.

Her academic and emotional well-being greatly improved. Since then, her mother no longer had to worry about her daughter threatening her with a knife.

If your kid’s anger is out of control, it’s important to get a complete evaluation to see if it may be due to child behavioral disorders, a traumatic brain injury (even a mild one), or a temporal lobe problem.

With proper treatment of the underlying issue, your child can stop feeling so angry and start feeling better fast. This will help them perform better at school, make friends more easily, and get along better with the whole family.

Press Play to See How a Young Boy Stopped Being So Mad All the Time

In this video, watch as a caring mother tried desperately to find a solution to her son’s explosive temper tantrums without success. Then see what turned it all around.

Click below to tune in:

UNDERSTANDING THE ROOTS OF YOUR CHILD’S ANGER

Anger is a natural human emotion that both adults and children experience. But when it becomes frequent, intense, and disruptive to your child’s daily life, you need to look beneath the surface.

When you understand what causes anger in children, you become more empowered to respond with empathy and compassion rather than frustration.

Here are some of the common triggers for anger in children:

1. Unmet Expectations

Do you always find yourself asking,” Why is my child so angry?” especially whenever they explode over issues that appear small? Research shows that exhaustion, overstimulation, hunger, or feeling ignored are needs that, when unmet, can escalate into outbursts.

2. Communication Challenges

Kids with explosive tempers are usually not able to express what they are feeling, more so when embarrassment, fear, or jealousy are at play. Being unable to find the right words or feeling misunderstood can make your child’s frustration build up so quickly that it results in yelling, defiance or aggression.

3. Environmental Stressors

Signs of anger issues in children can also emerge as a result of them being in an environment that feels unstable or overwhelming. Events like moving to another home, starting a new school, the arrival of a new sibling, or parental conflict can disrupt their sense of stability and safety.

Such stressors can spark insecurity and confusion, making the child easily irritable.

4. Developmental Stages

Research shows that some of the stages in child development are more emotionally intense compared to others. For instance, during the “terrible twos,” your toddler may want to do things by themselves, but they are yet to learn the skills to manage frustration.

Likewise, adolescents have social pressure and identity to deal with, which can make them more sensitive and reactive.

Both stages are characterized by a strong desire for autonomy, which may lead to frustration, anger, and power struggles, especially when they feel restricted or misunderstood.

5. Underlying Mental Health Conditions

In some children, chronic anger may be the result of deeper issues. Mental health issues like anxiety, ADHD, sensory processing difficulties, and oppositional defiant disorder (ODD) can alter how a child processes stimuli and regulates their emotions.

In such cases, anger may be a sign that a neuropsychological issue needs attention. If a child’s temper is leading to behavioral or school problems, it’s a sign there may be an underlying mental health problem.

STRATEGIES TO ADDRESS AND MITIGATE ANGER

Understanding how to deal with an angry child is an important step towards helping them through difficult emotions. So here are ways in which you can empower your child:

1. Encourage open communication.

Reassure your child that it’s OK to talk to you about how they feel at any time, even if they are angry. Frustrations in a child begin to ease when they feel heard and understood.

You can achieve that by using open-ended questions, for example, “Can you help me understand what happened?” and “What do you need right now to feel better?”

2. Teach simple coping mechanisms.

You can gently guide your child on how to manage emotions like anger by introducing coping tools that are simple and age appropriate. Help them regain control using techniques like:

Taking a deep breath
Slowly counting up to 10
Using phrases like “I need a break” or “I’m upset”

3. Establish consistent routines.

Studies show that children thrive in routines. Knowing what to expect can make your child feel safer.

You can lower your child’s anxiety and reduce their anger flare-ups by establishing regular mealtimes and bedtimes. Also, when change is unavoidable, try notifying them in advance.

4. Model appropriate behavior.

Your child will mirror how you handle stress in their presence. If you respond with self-control and calmness, they will start doing the same over time.

Try naming your emotions, too. For example, “I’m feeling so disappointed right now, so I’m going to take a deep breath.”

5. Know when to seek professional support.

If your child’s anger is frequent, feels overwhelming, or affects their relationships in school or at home, it’s time to reach out for professional support.

Functional brain imaging, such as SPECT, and child mental health assessments can be very instrumental in identifying underlying issues. Such evaluations can guide mental health experts in creating tailored treatment plans that work long-term.

CHILD ANGER QUIZ

Take this quiz to see if your child’s anger is out of control.

Is your child getting into trouble at school or at risk of being suspended or expelled due to anger, aggression, or fighting?
Is your child a danger to him/herself or to others?
Does your child get excluded from playdates and parties with other children because of problem behavior?
Do your child’s angry outbursts disrupt your home life and cause strife in the family?
Is your child too old to be having temper tantrums and meltdowns, but still having them?
Does your child feel guilty and frustrated because they can’t control their anger?

If you answered yes to any of these questions, it’s likely that your child would benefit from an evaluation. This doesn’t mean you’re a bad parent, and you definitely aren’t alone.

In fact, anger issues are one of the most common reasons why parents take their children to see a child and adolescent psychiatrist. Seeking help is a sign of strength, not weakness.

Anger issues, aggressive behavior, and other mental health conditions can’t wait. At Amen Clinics, we provide personalized, science-backed treatment plans designed to target the root causes of your symptoms. Our 360-approach includes brain SPECT imaging, clinical evaluations, innovative therapeutic techniques, medications (when necessary), and holistic lifestyle recommendations to promote the health of your brain, body, and mind. Speak to a specialist today at 888-288-9834 or visit our contact page here.

Amen Clinics

REFERENCES

National Center for Health Statistics. (2019). Health, United States, 2018 – Mental health. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK544286/

Rao, V., Rosenberg, P., Bertrand, M., Salehinia, S., Spiro, J., Vaishnavi, S., Rastogi, P., Noll, K., Schretlen, D. J., Brandt, J., & others. (2009). Aggression after traumatic brain injury: Prevalence and correlates. The Journal of Neuropsychiatry and Clinical Neurosciences, 21(4), 420–429. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2918269/

Kaźmierczak, I., Zajenkowska, A., Rajchert, J., Jakubowska, A., & Abramiuk-Szyszko, A. (2023). The Role of Anger Expression in Unmet Expectations and Depressive Symptoms. International Journal of Environmental Research and Public Health, 20(15), 1–20. https://doi.org/10.3390/ijerph20155900

Sukhodolsky, D. G., Smith, S. D., McCauley, S. A., Ibrahim, K., & Piasecka, J. B. (2016). Behavioral interventions for anger, irritability, and aggression in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 26(1), 58–64. https://doi.org/10.1089/cap.2015.0120

Selman, S. B., & Dilworth‐Bart, J. E. (2024). Routines and child development: A systematic review. Journal of Family Theory & Review, 16(2), 272–328. https://doi.org/10.1111/jftr.12549

Performance Anxiety: 5 Proven Ways to Overcome It

Amen Clinics
June 3, 2025

Discover 5 science-backed methods to overcome performance anxiety. Learn effective techniques to boost confidence and reduce stress naturally.

It’s normal to feel a few butterflies before a big moment. But when your heart starts pounding like a drum before public speaking, your hands go clammy before a friendly pickleball match, or your mind goes completely blank before a test—you may be dealing with performance anxiety.

Also known as stage fright, competitive anxiety, or “choking,” this intense fear of being judged or failing in high-stakes situations can affect anyone—students, athletes, executives, musicians, even romantic partners. And it’s far more common than most people realize.

In fact, up to 60% of individuals experience performance anxiety at some point in their lives, according to research in Frontiers in Psychology.

The good news? You don’t have to keep living at the mercy of your nerves. With the right strategies, you can train your brain and body to respond with calm instead of panic when you’re under pressure.

In this blog, we’ll explore science-backed stress management strategies to reduce performance anxiety—so you can step into the spotlight, the arena, or the boardroom with confidence and clarity.

Also known as stage fright, competitive anxiety, or “choking,” performance anxiety involves an intense fear of being judged or failing in high-stakes situations. And it can affect anyone.

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UNDERSTANDING PERFORMANCE ANXIETY

Performance anxiety is not considered a diagnosable mental health condition. Rather it falls under the umbrella of anxiety disorders, such as social anxiety or generalized anxiety disorder.

It typically occurs in situations where you’re expected to perform, be evaluated, or deliver results under pressure. It can show up in a wide variety of settings:

Professional environments
Academic challenges
Athletic competitions
Social interactions
Dating

While a little nervous energy can motivate you, excessive anxiety can interfere with your ability to think clearly, communicate confidently, and perform at your best. You may experience common symptoms like:

A racing heart
Heavy breathing/hyperventilating
Nausea or upset stomach
Tight muscles or tension headaches
Negative self-talk
Sweating
Freezing, or your mind going blank

In some instances, it can lead to a full-blown panic attack. If any of this sounds familiar, you’re in the company of some high-performing athletes, executives, and actors. The key to overcoming this is learning tools to manage those reactions and retrain your mind and body.

STRATEGY #1: PRACTICE RELAXATION TECHNIQUES TO OVERCOME PERFORMANCE ANXIETY

One of the most effective ways to overcome performance anxiety is through intentional relaxation techniques that calm your nervous system. These methods help shift your body out of fight-or-flight mode and into a calmer, more focused state mentally, emotionally, and physically.

How Relaxation Reduces Physical Symptoms of Performance Anxiety

When you’re anxious, your body releases stress hormones such as cortisol and adrenaline. This ramps up those physical symptoms and can make your thoughts race faster than you can think through them.

Relaxation techniques have been shown to reduce anxiety naturally by soothing your parasympathetic nervous system, which results in slower breathing, lower heart rate, and easing muscle tension.

Simple Relaxation Exercises to Incorporate into Your Routine

Here are a few simple stress management strategies you can try:

Deep breathing: Inhale through your nose and visualize filling your belly for four seconds, hold for four, exhale through your mouth for six. Repeat for two to five minutes.
Box breathing: Inhale for four, hold for four, exhale for four, hold for four. Repeat for at least 5 minutes to reset your nervous system.
Progressive muscle relaxation: First, find a comfortable place to lie down and breathe. Then, tense and release each muscle group, starting at your toes and moving upward.

The Long-Term Benefits of Relaxation for Anxiety Relief

Practicing relaxation regularly trains your body to respond more calmly in high-pressure situations wherever you are. Over time, these techniques can reduce anxiety naturally and become your go-to tools for navigating stress in healthier (and easier) ways.

Strategy #2: Build Confidence with Visualization Techniques

Another powerful strategy to overcome performance anxiety is through visualization—mentally rehearsing success. Visualization is one of the top boost confidence techniques used by athletes, public speakers, and performers because it works.

The Power of Visualization in Overcoming Anxiety

Visualization helps you tap into your brain’s ability to simulate experiences. When you vividly imagine yourself performing well, your brain fires off the same neural pathways as it would if you were actually doing it.

By making the event or goal feel familiar and less threatening, you end up reducing performance anxiety and achieving more than you thought you would.

Step-by-Step Guide to Effective Visualization for Anxiety Reduction

Find a quiet place and close your eyes.
Imagine the scenario where you feel performance anxiety—a meeting, stage, sports tournament, or test, for example.
Visualize yourself feeling calm, confident, and in control.
Include all five senses. What do you hear, see, feel, touch, or smell?
Repeat daily leading up to the event.

Why Visualization Works: Understanding the Mind-Body Connection

Visualization strengthens the mind-body connection by reinforcing positive expectations. When you “see” yourself succeeding, your body follows suit in action, which reduces performance anxiety and boosts self-trust over time.

You can also try guided imagery to help you relax and fall asleep when needed. Basically, this technique involves envisioning yourself in an imaginary environment—a tropical beach, a flower-filled meadow, or a cozy fireplace, for example—and taking in the sights, scents, and sounds. After visiting this imaginary place, you feel more relaxed.

STRATEGY #3: USE COGNITIVE BEHAVIORAL THERAPY (CBT) TO REFRAME NEGATIVE THOUGHTS

Cognitive behavioral therapy, or CBT, is a psychological approach that helps you identify and challenge the unhelpful thoughts driving your anxiety. By shifting your mindset, CBT allows you to reduce anxiety naturally and respond to stress with a plan.

How CBT Helps You Change Your Perception of Performance Anxiety

One of the best stress management strategies CBT offers is cognitive restructuring. Instead of thinking…

“I’m going to fail.”

…CBT can help you reframe your thoughts to…

“I’ve prepared for this, and I can handle it.”

This mental shift allows you to take back the mental control you need to reduce panic and restore balance in your life.

H3. CBT Techniques You Can Use to Manage Performance Anxiety

Try these CBT-inspired tools to help manage your performance anxiety:

Thought records: Write down your anxious thoughts and find evidence that supports or disproves them.
Exposure therapy: Test your fears by gradually taking small steps toward the thing you’re avoiding.
Affirmation replacement: Replace anxious self-talk with confidence-boosting affirmations.

Finding Professional Support for CBT

If you’re struggling to cope with persistent performance anxiety, working with a mental health professional can help you apply CBT principles in a more personalized way. Therapy offers a safe space to explore deeper fears and reduce anxiety naturally over time.

STRATEGY #4: ADOPT MINDFULNESS PRACTICES FOR BETTER FOCUS AND CALM

Mindfulness—the practice of being present without judgment—is one of the most reliable stress management strategies for reducing anxiety naturally. You can learn to stay focused during high-stakes moments by taking a moment to recenter yourself.

The Role of Mindfulness in Managing Anxiety

Mindfulness interrupts that spiral of anxious thoughts by grounding you in the present. This helps reduce anxiety naturally by shifting your attention away from what could go wrong and toward what is happening right now.

Easy Mindfulness Techniques to Practice Before a Performance

These can boost confidence techniques that help you center yourself before stressful events. Choose one or more to use when you need them:

5-4-3-2-1 grounding: Name five things you see, four you can touch, three you hear, two you smell, and one you taste.
Mindful walking or stretching: Move your body slowly while paying attention to each movement.
Body scan meditation: Bring awareness to each part of your body from head to toe.

How Mindfulness Can Improve Long-Term Stress Management

Consistent mindfulness practice improves emotional dysregulation, sharpens focus, and builds stress resilience. It makes this one of the most sustainable stress management strategies for managing performance anxiety long-term.

STRATEGY #5: DEVELOP HEALTHY LIFESTYLE HABITS TO MANAGE STRESS AND ANXIETY

Your everyday habits—how you eat, sleep, and move—play a major role in how your body responds to stress. Healthy routines can help you stay grounded and reduce the intensity of performance anxiety.

Research shows that eating the wrong foods can trigger anxiety at the moments when you need to be at your best. For example, eating a high-fat diet, getting inadequate amounts of protein, and consuming excessive amounts of sugar and refined carbohydrates can negatively impact focus, energy, and memory—all things you need when it’s time to perform.

Press Play to Learn How Caffeine Affects Anxiety

If you struggle with performance anxiety, you may want to check your caffeine intake. Too much java may be giving you the jitters.

Click below to tune in.

How Regular Exercise Can Reduce Anxiety and Boost Confidence

Decades of research on physical activity shows that it boosts mood-enhancing brain chemicals like serotonin and dopamine. Regular exercise is a beneficial way to reduce anxiety naturally, improve sleep, and help you feel more capable and in control.

The Importance of Sleep and Nutrition in Anxiety Management

You may already know that a lack of sleep and poor nutrition spikes cortisol (stress) levels. But did you know that they can also make you more reactive to stress?

Prioritizing rest and eating balanced meals can help your brain and body perform optimally. Proper sleep and nutrition help calm your body’s nervous system, so you don’t get so fearful when you need to perform.

Creating a Healthy Routine to Support Stress Management

To recap, here are a few simple habits that enhance your daily stress management strategies to calm anxiety:

Stick to a consistent sleep schedule
Eat whole, nutrient-dense foods
Move your body regularly
Limit sugar and caffeine
Stay hydrated

Fortunately, even these small changes can add up to greater emotional balance and resilience.

COMBINING TECHNIQUES FOR MAXIMUM CONFIDENCE AND PERFORMANCE

In most cases, no single method will solve performance anxiety overnight. The most effective approach is to combine multiple confidence-boosting techniques that work for your unique personality and lifestyle.

Building a Personalized Strategy to Overcome Performance Anxiety

To manage your performance anxiety, feel free to mix and match strategies that you’ll enjoy doing again and again:

Use mindfulness to ground yourself
Practice visualization before a big event
Apply CBT when negative thoughts arise
Relax your body through breathing
Maintain a healthy, active, and purposeful lifestyle

Performance anxiety doesn’t have to control your life. Creating your own personalized toolkit will help you be better prepared to handle any high-pressure situation with clarity and confidence.

FAQ

Is performance anxiety a mental health disorder?

Performance anxiety isn’t classified as a formal mental health disorder, but it falls under the broader category of anxiety-related issues. It’s closely related to social anxiety and can significantly impact quality of life if left unaddressed.

Can performance anxiety happen in non-public situations, like during intimate moments or job interviews?

Yes. Performance anxiety isn’t limited to public speaking or performing on stage. It can show up during athletic competitions, academic testing, work presentations, romantic relationships, and even one-on-one conversations—any situation where you feel pressure to perform.

What’s the best quick fix when I feel anxiety coming on right before a performance?

Try deep, slow breathing or box breathing to reset your nervous system. These techniques calm your body’s fight-or-flight response in minutes, helping you feel more grounded and in control when the pressure is on.

Amen Clinics

REFERENCES

Selman, S. B., & Dilworth‐Bart, J. E. (2024). Routines and child development: A systematic review. Journal of Family Theory & Review, 16(2), 272–328. https://doi.org/10.1111/jftr.12549

11 Warning Signs of Mental Health Issues You Should Know

Amen Clinics
June 2, 2025

11 subtle but serious mental health symptoms to watch for—early detection can lead to better outcomes and support when it matters most.

It’s easy to brush off a bad mood, poor sleep, or constant stress as “just life.” But what if these are early warning signs of something deeper?

Mental health problems often start quietly—subtle changes in thinking, feeling, or behavior that are easy to dismiss. Yet catching these mental health red flags early can make all the difference.

Whether you’re concerned about yourself or someone you care about, understanding the early symptoms of mental health issues is crucial. Ignoring them can lead to worsening symptoms, strained relationships, and even long-term consequences.

Here are 11 mental health warning signs you should never ignore—and what to do if you recognize them.

Mental health problems often start quietly—subtle changes in thinking, feeling, or behavior that are easy to dismiss. Yet catching these mental health red flags early can make all the difference.

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SLEEP CHANGES

When your sleep patterns start to change drastically, it could signal a potential mental health issue. For example, significant shifts in your circadian rhythm or physical health—such as insomnia or oversleeping—often point to conditions like depression or anxiety.

In a 2019 study, up to 90% of people with depression experienced sleep disturbances. Sleep problems can exacerbate feelings of stress and become a cycle that’s difficult to break.

2. APPETITE OR WEIGHT SHIFTS

Similarly, whether eating too little or too much, changes in your appetite can indicate underlying mental health conditions like depression, anxiety, or eating disorders. Sudden weight gain or weight loss can also be a sign of a mental disorder.

For example, research shows that appetite and weight fluctuations are common in people with major depressive disorder. Some people lose their appetite while others feel hungrier than usual.

3. MOOD CHANGES

If you’re experiencing low moods or having rapid or dramatic shifts in mood, it could be an indicator of a mental disorder. Persistent feelings of sadness, emptiness, or irritability are common signs of depression, which affects 29% of US adults at some point in their lives, according to a recent Gallup Poll.

On the flip side, feelings of euphoria that come and go may make you feel amazing in the short-term but might be a sign that something’s wrong. For example, people with bipolar disorder might fluctuate between high-energy manic states and deep depressive episodes.

If you or someone you know is experiencing chronic low moods or extreme emotional ups and downs, it could be time to seek help from a mental health professional.

Press Play to Discover the Warning Signs of Mood Disorders

In this video, Amen Clinics psychiatrist Dr. Jay Faber reveals a specific behavior pattern that’s a common sign of bipolar disorder.

4. SOCIAL WITHDRAWAL

If you’re increasingly isolating yourself from social activities or withdrawing from relationships you once enjoyed, it could signal a deeper issue that needs to be evaluated. Loss of interest in previously enjoyed activities or avoiding interactions with friends and family can be a sign of depression or other mental health conditions.

Understand that this is not about the natural progression of certain relationships or growing out of certain hobbies. This is about having the desire to want to enjoy those parts of your life again—except your mind isn’t allowing you to feel that desire and continue enjoying it.

Social withdrawal is often linked to a lack of energy or motivation, both of which are common when dealing with mental health disorders. A NIMH report showed approximately 20% of U.S. adults experience some form of mental illness annually, with social withdrawal being a hallmark symptom.

5. TROUBLE WITH DAILY FUNCTIONING

If you are someone who previously excelled at work, school, or social activities, but you’re suddenly struggling to keep up with your tasks, it could indicate mental health issues. Research shows that it’s important to pay attention to daily functioning problems, such as:

Neglecting responsibilities and/or hygiene
Difficulty completing basic tasks like cleaning or organizing
Struggling to meet deadlines or keep up with workload demands
Experiencing difficulty concentrating or retaining information
Forgetting important appointments, commitments, or responsibilities

These may be signs of mental health issues, such as depression, anxiety, bipolar disorder, or attention deficit hyperactivity disorder (ADHD), also known as attention deficit disorder (ADD). When these are left untreated, your ability to work and interact socially can be significantly and negatively impacted.

If your performance has noticeably decreased in one or more areas of life, it’s important to explore the possibility of a mental disorder with a trusted and qualified mental health professional.

6. DIFFICULTY FOCUSING

Everybody experiences times when it’s challenging to stay on task. But if your problems with focus and concentration persist and get in the way of your success, it could be a sign of trouble. Focus and attention problems are hallmark signs of ADHD, but they can also be linked to other mental health disorders.

For example, research shows that cognitive issues like poor focus are experienced by nearly 50% of people with depression and anxiety disorders. If these symptoms interfere with work or daily life, you need to seek professional help to assess potential mental health disorders.

7. HEIGHTENED SENSITIVITY

A heightened sensitivity to environmental stimuli—think light, sounds, smells, or textures—can signal an overactive nervous system. This is then often triggered by stress, anxiety, or trauma.

If you find yourself avoiding public places, loud environments, or large crowds because you become overwhelmed by external stimuli, it could be a red flag. Your hypersensitivity may be a sign of posttraumatic stress disorder (PTSD), ADHD, or anxiety.

The Anxiety and Depression Association of America (ADAA) reports that anxiety disorders affect 40 million adults in the U.S. Many of those struggling with anxiety disorder also experience sensory sensitivities or overload as part of their condition.

8. FEELING NUMB OR DETACHED

When you start to feel detached from yourself or your surroundings, or lose interest in life, it’s important to give yourself space to learn why. This feeling of disconnection, also known as depersonalization, can make a person feel as though they are observing life from the outside.

This symptom is common in those with major depressive disorder, where emotional numbness can take over and result in apathy toward daily activities or people. If you find yourself or a loved one lacking initiative or experiencing emotional numbness, it’s important to seek help from a mental health professional.

9. ILLOGICAL OR DISORDERED THINKING

Mental disorders like bipolar disorder or schizophrenia can cause illogical thinking or delusions that lead people to believe in exaggerated or false thoughts about themselves or the world. These beliefs might include thoughts of grandeur or the idea that you have special powers to control events around you.

According to the World Health Organization, approximately 1 in 300 people worldwide experience schizophrenia in their lifetime, often manifesting as distorted thinking and perceptions. If someone’s beliefs seem out of touch with reality or become more outlandish, it may indicate a serious mental health condition that requires intervention.

10. NERVOUS OR FEARFUL BEHAVIOR

Excessive nervousness, fear, or paranoia can be symptoms of anxiety disorders, including generalized anxiety disorder (GAD) or social anxiety disorder. Uncharacteristic behavior like erratic speech or avoiding everyday tasks due to irrational fears, often points to an underlying issue.

The NIMH reports nearly 30% of adults in the U.S. experience an anxiety disorder in their lifetime. Most of them report symptoms such as hypervigilance and hyper-avoidance of triggering situations. If you or someone you love seems to be living in constant fear, it may be time to seek professional mental health guidance.

11. CHANGES IN SCHOOL OR WORK PERFORMANCE

A sudden change in your performance at school or work can be an early warning sign of a mental disorder. Such changes may include:

Finding it difficult to keep up with responsibilities
Having trouble staying focused
Increased absenteeism
Experiencing conflicts with colleagues or classmates

If your productivity isn’t what it used to be, you may want to take a deeper dive to investigate what’s causing the drop in performance.

FINAL THOUGHTS: DON’T IGNORE SIGNS OF MENTAL HEALTH ISSUES

Recognizing mental health symptoms early can be critical to getting the right help and support. They should not be dismissed lightly. Getting an early diagnosis means early intervention, so you can better manage your symptoms and improve your overall quality of life.

Anxiety, depression, and other mental health conditions can’t wait. At Amen Clinics, we provide personalized, science-backed treatment plans designed to target the root causes of your symptoms. Our 360-approach includes brain SPECT imaging, clinical evaluations, innovative therapeutic techniques, medications (when necessary), and holistic lifestyle recommendations to promote the health of your brain, body, and mind. Speak to a specialist today at 888-288-9834 or visit our contact page here.

Amen Clinics

REFERENCES

Stickley, A., Leinsalu, M., DeVylder, J.E. et al. Sleep problems and depression among 237 023 community-dwelling adults in 46 low- and middle-income countries. Sci Rep 9, 12011 (2019). https://doi.org/10.1038/s41598-019-48334-7 https://www.nature.com/articles/s41598-019-48334-7#citeas

Simmons, W Kyle et al. “Depression-Related Increases and Decreases in Appetite: Dissociable Patterns of Aberrant Activity in Reward and Interoceptive Neurocircuitry.” The American journal of psychiatry vol. 173,4 (2016): 418-28. doi:10.1176/appi.ajp.2015.15020162

Witters D. U.S. Depression Rates Reach New Highs, GALLUP. May 17, 2023. https://news.gallup.com/poll/505745/depression-rates-reach-new-highs.aspx

National Institute of Mental Health. (2024, September). Mental Illness. www.nimh.nih.gov/health/statistics/mental-illnesshealth

Keller AS, Leikauf JE, Holt-Gosselin B, Staveland BR, Williams LM. Paying attention to attention in depression. Transl Psychiatry. 2019 Nov 7;9(1):279. doi: 10.1038/s41398-019-0616-1. Erratum in: Transl Psychiatry. 2020 Feb 12;10(1):64. doi: 10.1038/s41398-020-0748-3. PMID: 31699968; PMCID: PMC6838308

Perini G, Cotta Ramusino M, Sinforiani E, Bernini S, Petrachi R, Costa A. Cognitive impairment in depression: recent advances and novel treatments. Neuropsychiatr Dis Treat. 2019 May 10;15:1249-1258. doi: 10.2147/NDT.S199746. PMID: 31190831; PMCID: PMC6520478

National Institute of Mental Health. (2024). Any Anxiety Disorder. Retrieved from www.nimh.nih.gov/health/statistics/any-anxiety-disorder

The Risk Perception Gap: Why We Fear the Unlikely

Amen Clinics
May 5, 2025

Most of us panic about rare dangers while ignoring real, everyday threats. Here’s the neuroscience why and what to do about it.

Have you ever wondered why dramatic news stories easily get you into panic mode, but warnings about the everyday habits that threaten your health don’t phase you?

This kind of mismatch is called the risk perception gap, a phenomenon that influences how our brains prioritizes fear. If there’s a news alert about contaminated vegetables, for example, people will rush to throw out all their groceries and warn their loved ones about it.

Interestingly, later that day, those same people will grab fast food, even though we all know that poor diet is linked to health issues like diabetes and heart disease. In general, we tend to overestimate the danger posed by rare events and underestimate more prevalent risks.

In this blog, we will unpack why our brains work this way, how it affects the decisions we make, and what we can do to focus on the real dangers.

Have you ever wondered why dramatic news stories easily get you into panic mode, but warnings about the everyday habits that threaten your health don’t phase you? This kind of mismatch is called the risk perception gap.

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WHAT IS THE RISK PERCEPTION GAP?

The risk perception gap is the discrepancy between how risky something actually is based on statistics or facts and how risky people think it is based on their personal beliefs, feelings, or instincts. According to research, this is a case of risk misperception where people categorize threats based on emotions rather than rationality or reason.

For instance, some people may have an intense fear of occurrences like plane crashes, even though they are very rare, yet they underestimate more common and fatal risks like car accidents or heart disease. Such misperception leads to complacency or unnecessary fear as people try to manage real-world risks.

COGNITIVE BIASES THAT DISTORT RISK PERCEPTION

Our brains often rely on mental shortcuts, also known as cognitive biases, to simplify information processing.

These biases can be useful in quick decision-making, especially when managing complex life situations in limited time. Even so, cognitive bias and fear usually work hand in hand, bypassing logical thinking in favor of past experiences or instincts.

So, what are some of the most common cognitive biases? Here are four mental shortcuts that distort thinking:

Availability Heuristic

This is an important element of the risk perception psychology that explains how we judge the probability of an event based on how easily we can recall instances or examples. In most cases, this results from the level of attention some of these events receive from the media.

For example, after hearing about a plane crash, you are more likely to believe that air travel is riskier than it actually is. You may overestimate such a risk just because that memory is still fresh in your mind.

Neutral Bias

Our brains are hardwired to focus more on negative information than positive or neutral information. Naturally, your mind is attracted to negative emotions, experiences, or events because they are usually viewed as threatening or urgent.

For instance, if you see numerous positive reviews about a product but only one negative review, you’re more likely to focus on and remember the negative review. This can influence your decisions based on fear and caution rather than rationality.

Probability Neglect

Probability neglect is the cognitive bias where emotions like excitement or fear can cloud your judgment, making you overlook the actual likelihood of an event taking place.

For instance, watching a horror movie can make you so scared that you believe something dangerous could be lurking around you. This feeling of fear can make you exaggerate the risk in your mind and overlook the reality of the matter.

Anchoring Bias

This is about how we tend to rely heavily on the first bit of information we come across, to make judgements or decisions. This piece of information is called the anchor. Anchoring bias causes your brain to cling to the first information you received and use it to judge everything that follows.

As an example, let’s say you hear that a certain purse costs $1,000. That price will stick in your mind. But later when you see a similar bag being sold for $700, it will feel like a bargain even though it’s still costly.

THE ROLE OF THE BRAIN

To understand how the brain assesses risk, let’s begin by examining the key areas and processes involved in rational and emotional thinking:

· The Amygdala

This part of the brain processes emotions, especially fear. Once the amygdala senses a potential threat, it initiates an immediate emotional response that is meant to protect you.

This usually happens even before the logical regions of your brain get time to assess the situation. This is why you may react impulsively, and in some cases, overestimate risks based on emotions rather than reason.

· The Prefrontal Cortex

This region is responsible for advanced-level thinking processes like planning, rational decision-making and impulse control. In essence, this is the part of the brain that helps in logical risk assessment. It allows you to carefully weigh facts.

That said, whenever you have strong emotions like fear, your prefrontal cortex gets overpowered by the amygdala. That results in distorted judgment, which can cause you to prioritize immediate emotional reaction instead of careful reasoning.

MEDIA AMPLIFICATION OF UNLIKELY RISKS

Media coverage plays a significant role in influencing how our brains perceive risks. Research shows that through dramatic and emotionally charged reporting, the media heavily amplifies threats that are unlikely to actualize.

Unusual events like terrorist incidents, shark attacks, or airplane crashes often grab public attention as they trigger intense emotional reactions. That can lead to distorted risk perception, whereby, as a viewer, your fears become misaligned with the actual probabilities.

Social media algorithms often highlight shocking content, which induces fear. It makes uncommon occurrences seem more frequent than they actually are. As a user, you find yourself constantly worrying about rare dangers while overlooking everyday risks.

Press Play to Find Out Why We’re Addicted to Fear

In this video, health and wellness expert and bestselling author Tana Amen shares why she stopped watching the news and how you need to take notice of what’s driving your fears.

Click below to tune in:

REAL RISKS WE OFTEN IGNORE

This gap between rare vs. real dangers often goes unnoticed, more so because of the dramatic headlines that steal the spotlight. While we’ve been conditioned to focus on the rare dangers, the risks that quietly affect our environment, physical, and mental health tend to slip under the radar.

Having a clear understanding of the brain and risk assessment will save you from unnecessary panic and help you to focus on avoiding or addressing the real dangers.

Factors like lack of exercise, poor diet, excessive alcohol, and smoking continue to pose major health risks. Similarly, chronic stress, among other untreated mental health-related issues, have been silently eroding the quality of life for many.

At the same time, people have been exposing themselves to long-term air pollution, among other invisible health hazards, oblivious to the fact that they contribute to diseases and premature death. These are the real dangers, but unfortunately, they receive far less attention.

HOW TO TRAIN YOUR BRAIN FOR RATIONAL RISK ASSESSMENT

Understanding why you fear the wrong things is just the first step. Next, it’s important to focus on practical ways to restructure your thinking. Rather than relying on fear-based assumptions, you can rewire your response patterns by taking the following simple steps:

1. Embrace Cognitive Behavioral Techniques

These are tactics that will help you identify your distorted thought patterns and replace them with more rational perspectives.

For instance, if you are always assuming the worst when someone doesn’t respond to your messages right away, pause and ask yourself, “Is there real evidence that something is wrong, or am I just jumping to conclusions?” Consider alternative explanations; “Perhaps, they haven’t seen the messages yet.”

2. Practice Mindful and Grounding Exercises

If you notice that your emotions are taking over in any situation, pause and redirect your focus on your breathing, sounds, or even the physical sensations around you. These exercises will calm your nervous system, allowing you to think more clearly.

3. Improve Your Statistical Literacy

In today’s world, where there is constant media fearmongering, it’s a good idea to get familiar with basic probabilities. Researchers in Germany suggest adopting a habit of questioning any dramatic claims you come across. Always ask, “How likely is this risk?” This will allow you to focus on real concerns.

YOU HAVE MORE CONTROL THAN YOU THINK

Say no to living in a constant state of unnecessary fear. Understanding the way your brain works can help you redirect your focus to risks that matter rather than exaggerated threats. The good news? The risk perception gap isn’t permanent. You can rewire it with intention and practice.

All you have to do is begin with one small action. At the end of the day, take time to reflect on a fear you’ve always had and ask, was it about facts or just feelings? Noticing when it’s your emotions or objective data that are influencing your fears is how you are going to reshape your worldview over time.

Also, limit the amount of time you spend every day consuming content that makes you feel overwhelmed with fear. Remember, five minutes of watching doom-laden news can hijack your emotional state for days. Replace that with reading a self-help book, engaging in mindful meditation, or some other form of relaxation.

COMMON CAUSES OF MENTAL HEALTH SYMPTOMS

Without using functional brain scans—such as SPECT (single photon emission computed tomography) or QEEG (quantitative electroencephalogram)—your doctor cannot tell if your inattention, depression, compulsions, mood swings, or aggression is from:

Seizure activity
Nutrient deficiencies
Hormonal imbalances
A genetic abnormality
Undiagnosed sleep apnea
Blood sugar abnormalities
A premature aging process
Infections, such as Lyme disease
Low blood flow from vascular disease
A brain that is working too hard and needs to be calmed down
A brain that is not working hard enough and needs to be stimulated
An inflammatory process, related to low omega-3 fatty acids or gut problems
Lasting physical trauma from a car accident or from playing football in high school
Toxic exposure from carbon monoxide or mold exposure, which needs to be treated

If mental health professionals don’t look at the brain, they are unnecessarily flying blind. That can lead them to miss important diagnoses, give the wrong treatment plan, and hurt the people they are entrusted to help.

HOW TRADITIONAL PSYCHIATRY MISSES THE ROOT CAUSES OF MENTAL ILLNESS

Jason is a prime example of how not looking at the brain can be life-threatening. He was 18 and in his first year in college at the University of Rhode Island when he first started hearing voices and having visual hallucinations.

Based on his symptoms, the university psychiatrist diagnosed him with schizophrenia and told his parents he would need to be on antipsychotic medication for the rest of his life. But the medication triggered suicidal thoughts.

Horrified, his mother called Amen Clinics, where Jason underwent a functional brain-imaging study.

Jason’s SPECT scan showed evidence of a past brain injury affecting his left temporal lobe, which when damaged is often involved in mood instability, dark thoughts, and hallucinations. It also showed low activity in his frontal lobes (where focus, forethought, and planning occur).

When he was 5 years old, Jason jumped headfirst into an empty bathtub and was unconscious for a brief period. He also had sustained several concussions from wrestling and playing soccer.

Since the age of 5, Jason had struggled with low-grade depression. His symptoms worsened when he was 12 years old and experienced bullying at school.

While at college, Jason started hearing voices. They constantly made mean comments about him and others. Often, the voices would speak at the same time. In addition, he began seeing gory visions of his own death, including being strangled by a snake.

After a comprehensive evaluation at Amen Clinics, including his personal history, SPECT brain scans, neuropsychological assessments, and more, his diagnosis changed.

Jason didn’t have schizophrenia. Rather, he had experienced a psychotic depression, which had been made worse by the prior brain injury, undisciplined thought patterns, and chronic stress.

Jason stopped taking his antipsychotic medication and began supporting his brain recovery with healing nutrients and cognitive behavioral therapy (CBT). He also did multiple sessions of hyperbaric oxygen therapy (HBOT) to help heal his prior brain injury.

Within 4 months, Jason was remarkably improved and the following year he was back at school. If no one had ever looked at his brain and put him on a more effective treatment plan, his life would have been very different.

BENEFITS OF BRAIN IMAGING IN PSYCHIATRY

Functional brain imaging takes psychiatry from a generalized symptom-cluster diagnostic and treatment specialty without any biological evidence to a more objective specialty, one that is solidly based on using state-of-the-art brain mapping tools to help optimize the patient’s brain function.

Besides completely changing the way mental health professionals diagnose mental health disorders, functional imaging leads to completely different treatment protocols to improve brain function.

By finding the root causes of your symptoms—such as exposure to toxic mold, Lyme disease, or a past head injury—you can get more targeted treatment that works.

For example, if your depressive symptoms are related to toxic mold exposure, it’s unlikely that antidepressant medications are going to help. Unless you eliminate the mold, you’re going to continue struggling with low moods.

Similarly, if Lyme disease is causing psychotic episodes, but you’re diagnosed with schizophrenia, antipsychotics won’t work. You have to treat the underlying infection.

When brain scans help a psychiatrist get to the root causes, you’re more likely to feel better faster.

Looking at the brain also leads to more natural strategies to treat mental health conditions. Seeing areas of the brain that are either overactive or underactive helps physicians pinpoint lifestyle habits to optimize brain function.

If you’re struggling with mental health symptoms that aren’t responding to traditional treatments or psychiatric medications, it’s a good idea to consider a brain scan. Additional biological information can be so helpful in discovering why you feel depressed, anxious, angry, or unfocused. And it can give you a clearer roadmap to healing.

ADHD SYMPTOMS IN WOMEN

Most people think of ADHD as a condition that is primarily seen in males who are hyperactive and impulsive. In fact, women are just as likely as men to have ADD, according to a paper in The ADHD Report.

Surprisingly, a study in the Journal of Clinical Psychiatry found that ADD symptoms in women are often more severe ADHD symptoms than their male counterparts. But women tend to have a different type of the condition that comes with its own set of symptoms.

The brain-imaging work at Amen Clinics, which has the world’s largest database of functional brain scans related to behavior, has helped identify seven types of ADD.

The type that is most common in females is called Inattentive ADD. Although it’s the second most common type of ADHD, its symptoms go unrecognized by many medical professionals.

Related: Learn More About the 7 Types of ADD

Click on the link to access your free ebook: Getting to Know the ADD Types

Unfortunately, many women with Inattentive ADHD never get diagnosed. Instead, they’re labeled as slow, lazy, spacey, or unmotivated.

While people with Classic ADD, the most common type of the condition, bring negative attention to themselves with their hyperactivity, constant chatter, and conflict-driven behavior, women with Inattentive ADD tend to be quiet and distracted.

Rather than cause problems, they’re more likely to daydream or look out the window. They’re not as likely to be impulsive or to blurt out inappropriate or hurtful things. They’re frequently thought of as couch potatoes who have trouble finding interest or motivation in their lives.

Core symptoms of ADHD include:

Easily distracted

Short attention span
Difficulty following through (procrastination) on tasks or instructions
Difficulty keeping an organized area (room, office, desk, filing cabinet, car, etc.)

Has trouble with time, for example, frequently late or hurried, tasks take longer than expected, projects are “last minute” or turned in late
Forgetfulness
Problems with follow-through

Poor impulse control

Unique symptoms of Inattentive ADD include:

Problems with focus
Tendency to lose things

Makes careless mistakes
Poor attention to detail

Forgetful
Excessive daydreaming
Complaints of being bored
Apathy or lack of motivation
Tired, sluggish, or slow moving
Seems spacey or preoccupied

Women with adult ADHD are also more likely than men to have co-existing anxiety and depression, as well as sleep problems. This can make it more difficult to detect ADD in women and is another reason why brain imaging can be so helpful in getting an accurate diagnosis.

Many of the women who come to Amen Clinics with undetected ADHD had previously been diagnosed with mood disorders or other issues. Untreated ADHD in female adults can lead to serious consequences.

CONSEQUENCES OF UNTREATED ADHD

Having undiagnosed or untreated ADD comes with a very high cost. And it increases the risk of many other issues, including:

Anxiety
Depression
Addiction
Eating disorders
Obesity
Obsessive compulsive disorder (OCD)
Post-traumatic stress disorder (PTSD)
Sleep disorders
Divorce
Career problems

Press Play for Insights on ADHD and Relationships

Hosted by Dr. Daniel Amen and Tana Amen, this episode of the Change Your Brain Every Day podcast explores how ADHD can wreak havoc on relationships and intimacy. Click below to tune in.

This causes many women with untreated ADHD to engage in unhealthy strategies to deal with their symptoms. For example, some may seek out stimulating substances or risky behaviors to cope with their issues.

Others may turn to antidepressant medications, anti-anxiety pills, and other medications to manage their discomfort. Not only are these medications ineffective in treating the underlying ADD, they also come with unwanted side effects.

Ultimately, it can lead to a downward spiral that leaves you feeling unfulfilled and unhappy with yourself and your life.

INATTENTIVE ADHD AND THE BRAIN

On her social media post, Clery shared her brain SPECT imaging studies, which showed low activity levels in the front part of her brain, especially when she tried to concentrate.

In people who don’t have ADD, concentration typically activates an area of the brain called the prefrontal cortex, which is involved with:

Focus
Time management
Planning
Organization
Critical thinking

In adults with ADHD, however, concentrating reduces activity here, making it difficult to pay attention. This is why simply telling someone with ADD to “try harder” or blaming them for not having enough willpower doesn’t help. Brain imaging shows that the harder they try, the worse it gets.

The prefrontal cortex is also involved in sustaining attention span. It trains your mind to focus on important information while filtering out less significant thoughts and sensations. Attention span is required for short-term memory and learning.

Through its many connections within the brain, the prefrontal cortex keeps you on task and allows you to stay with a project until it is finished. This brain region accomplishes this by sending quieting signals to other parts of the brain.

In the face of a need to focus, the prefrontal cortex decreases the distracting input from other brain areas, inhibiting rivals for our attention. However, when this brain region is underactive, less of a filtering mechanism is available and distractibility becomes common.

Studies show that problems in the prefrontal cortex often lead to decreased attention span, distractibility, impaired short-term memory, decreased mental speed, apathy, and decreased verbal expression. Underactivity or damage in the PFC can also lead to a decreased ability to express thoughts and feelings.

These are things women with ADHD may experience. However, they often chalk it up to being lazy, ditzy, or depressed rather than thinking it might be related to their brain function.

TREATING ADHD IN WOMEN

The brain-imaging work at Amen Clinics shows that even if your prefrontal cortex is underactive and you’ve had undetected ADHD for decades, you can still optimize your brain function and enhance your life.

With the right treatment, you can be more focused, more organized, and more motivated to reach your goals. This has positive implications for every area of your life—career, health and fitness, relationships, and self-esteem.

Many women assume that ADHD medication is the only treatment option. ADHD medications can be very effective for some people with the condition. Giving someone with ADHD stimulant medication can be like giving glasses to someone who has vision problems.

However, in some women, medications for ADHD can make symptoms worse. Every woman is different and requires a personalized treatment plan.

At Amen Clinics, targeted ADHD treatment plans may include diet recommendations, specific forms of exercise, personalized supplement suggestions, neurofeedback, behavioral interventions, psychological strategies, and medications (when necessary).

Related: Natural Ways to Help ADD

The good news is Inattentive ADD in women is usually very responsive to the right treatment. With an accurate diagnosis and the proper treatment program, you can change your brain, stop feeling bad about yourself, and start living the life you want.

HOW HEAT THERAPY SUPPORTS BRAIN HEALTH

Heat therapy is beneficial for health because it relies upon the body’s natural response to heat. Since the body works to maintain its baseline temperature, the application of heat is interpreted as a stressor. Through the process of adapting and readjusting, the body builds greater stress resilience.

Are saunas good for brain recovery? Research suggests that heat therapies like saunas (and infrared saunas) also help by boosting circulation, which promotes the delivery of oxygen and nutrients to the brain. A 2018 study reported that saunas reduce the risk of vascular diseases, including neurocognitive diseases. They also can improve mortality and soothe common conditions like arthritis, headache, and flu.

These benefits were linked to saunas’ positive effects on the body’s circulatory, cardiovascular, and immune systems. The study noted that improved cardiovascular function occurred as a result of numerous factors, including:

Widening of blood vessels
Reduced arterial stiffness
Autonomic nervous system regulation
Beneficial changes in the blood’s circulating lipids
Lowering of systemic blood pressure

Cardiovascular health and mental health are closely interrelated, and these changes are beneficial for the brain, too. For example, a study published in 2020, which tracked nearly 14,000 men and women over 39 years, found that the practice of sauna bathing was associated with a reduced risk of dementia.

A narrative review published in Frontiers in Physiology explored the mechanisms behind this finding. Neurodegenerative diseases like Alzheimer’s disease and Parkinson’s disease are associated with a loss of protein homeostasis. But heat shock proteins (HSPs), which are produced in response to stress (such as heat therapy), may protect against the protein changes seen in these diseases.

The review outlined various benefits of heat therapy, thanks to its ability to elevate HSPs:

Prevents or reduces the toxicity of protein accumulation
Enhances neuromuscular function
Improves muscle function, cerebral blood flow, and metabolic health
Protects against neurodegeneration, leading to reduced risk of developing neurodegenerative disease

Finally, exposure to heat promotes relaxation, helping to reduce stress and anxiety. A 2021 narrative review that evaluated heat therapy for pain management established that its benefits function in multiple ways within the body:

Activating temperature-sensitive nerve endings that block the processing of pain signals
Blocking the transmission of pain signals to the spinal cord and the brain (when used with pressure)
Relaxing muscles
Increasing flexibility and range of movement
Reducing stiffness in tissues and enhancing tissue extensibility
Increased metabolism and vasodilation, which increases blood flow and speeds up healing processes
Enhanced muscle strength

Interestingly, the review pointed out that heat’s pain-relieving effects “are partly mediated by transient receptor potential (TRP) membrane channels, of which seven respond to heat and two respond to cold temperatures.”

Press Play to Learn More About How Saunas Benefit the Brain and Body

In this video, Dr. Amen reveals some of the best ways to support the health of your brain and body, including how saunas can help. Click below to tune in.

COLD THERAPY: THE BRAIN-BOOSTING BENEFITS OF CRYOTHERAPY

When comparing cold therapy vs. heat therapy benefits, it’s important to first understand the goals of the treatment. Each offers different benefits for the body and brain.

How does cryotherapy help brain health? Cold therapy, like ice baths, cryotherapy, and cold plunges, has been shown in a 2021 study to reduce neuroinflammation, which can contribute to symptoms like depression and brain fog.

Another study, published in 2024, noted that exposure to cold provokes numerous positive effects in the body, including the brain, due to a stress response like the one involved in heat therapy.

In response to cold, hormones, neurotransmitters, growth factors, and cytokines (proteins that play a role in inflammation and immune response) are released into the bloodstream and the brain. The study added that a mild stressor like cold-water immersion can:

Activate neuroprotective pathways, decreasing neuroinflammation and neurodegenerative processes
Trigger the release of hormones and neurotransmitters, such as dopamine, serotonin, cortisol, norepinephrine, and β-endorphins. These are all linked to stress resilience and the emotion-related circuits impacted by depression, anxiety, and post-traumatic stress disorder (PTSD).
Alleviate pain
Facilitate higher alertness, motivation, and energy
Reduce feelings of nervousness and distress
Increase the neural interaction between large-scale brain circuits (including prefrontal cortices and the anterior cingulate cortex)

A previous study found numerous positive effects of cold-water immersion at about 57°F. Subjects showed a 350% increased metabolic rate, while noradrenaline and dopamine concentrations were increased by 530% and by 250%, respectively.

At the same time, cortisol concentrations tended to decrease. All of these changes help boost motivation and mental clarity while offering a stress-reducing effect.

Cold therapy has also been studied for its assistance in muscle recovery. A 2024 review noted its benefits for reducing soreness and improving functional recovery after exercising, due to its ability to narrow blood vessels. This leads to:

Reduced inflammation and tissue metabolism
Pain reduction
Neuromuscular and hormonal changes
Decreased muscle swelling
Preventing injuries by improving tissue function and joint stability (leading to faster recovery)

HOW TO INCORPORATE HEAT AND COLD THERAPY INTO YOUR ROUTINE

When it comes to heat vs. cold, what’s the best temperature therapy for brain recovery? That depends on your goals. Here’s a quick summary to help you decide:

If you’re looking to reduce stress and anxiety, choose heat therapy. This can include saunas, warm baths, heated compression (such as a heat wrap), heating pads, and hot tubs or baths.

To reduce brain inflammation and promote recovery, choose cold therapy. This includes ice baths, cold plunge pools, cryotherapy, ice packs, and cold showers.

To optimize mental performance, alternate between both. This is called contrast therapy, and it’s been used for years to promote emotional well-being.

A study published in 2023, which examined the results of pairing a hot sauna with cold water, found that this combination created a more efficient brain. Subjects’ response time while completing behavioral tasks decreased significantly, indicating more alertness and mental clarity.

At the same time, participants reported perceived improvements in their physical relaxation and positive emotions.

Fortunately, incorporating hot and cold therapies into your routine can be a simple process performed at home—using heating pads, hot baths, and ice packs, for example.

With any temperature therapy, ensure a safe and effective amount of exposure. For example, a study found that men who used saunas four to seven times weekly, and in longer sessions (11-19 minutes or longer) were found to receive the most health benefits, including cardiovascular health and improved mortality.

However, too much exposure can be dangerous for health. As one case study found, sauna sessions of 30-60 minutes can lead to heatstroke, organ failure, and even coma.

Cryotherapy and cold exposure can also have adverse impacts if performed excessively or incorrectly, including hypothermia, burns, frostbite and nerve damage. A 2023 review evaluating these and other risks warned that they are preventable by utilizing proper procedures and safety recommendations.

Therefore, discuss any new therapy modality with your healthcare professional to find the right exposure for you.

THE FUTURE OF HEAT VS COLD THERAPY FOR BRAIN HEALTH

While modern medicine continues to make major advancements in technology and scientific study, some of humans’ most helpful healers are age-old—including cold and heat therapies.

Still, new research continues to emerge on the benefits of thermal therapies for brain injury, mental health, and cognitive decline. We can expect to learn more about how, why, and when they’re most helpful. We may also learn more about how temperature regulation might play a role in neuroplasticity and brain repair.

Ultimately, the more knowledge we have, the more individuals can take advantage of personalized approaches, finding the most effective mix of cold and heat therapies to meet their unique needs.

ARCHIVE

Misdiagnosed with Depression? It Could Be Bipolar Disorder

JENNA’S STORY: WHEN ANTIDEPRESSANTS BACKFIRE

WHY BIPOLAR DISORDER IS SO OFTEN MISDIAGNOSED AS DEPRESSION

WHAT DEPRESSION AND BIPOLAR HAVE IN COMMON

Depression

Bipolar Disorder

Depression and Bipolar Disorder: Shared Symptoms

MANIC AND HYPOMANIC SYMPTOMS THAT SET BIPOLAR APART

Hypomania

Mania

THE DANGERS OF THE WRONG TREATMENT

UNDERSTANDING THE FOUR TYPES OF BIPOLAR DISORDER

THE TURNING POINT: GETTING A BRAIN-BASED DIAGNOSIS

WHY SEEING THE BRAIN CHANGES EVERYTHING

FAQ

Amen Clinics

Why You’re Feeling Angry Lately—and How to Cool Down

THE RISKS OF UNRESTRAINED ANGER

THE NEUROBIOLOGY OF ANGER: UNDERSTANDING THE BRAIN’S ROLE IN AGGRESSIVE BEHAVIOR

Neurotransmitters and Hormones Influencing Anger

Understanding the Brain’s Anger Circuitry

WHAT BRAIN SCANS REVEAL ABOUT ANGER AND AGGRESSION

6 ANGER MANAGEMENT STRATEGIES

THE BOTTOM LINE ON ANGER AND YOUR BRAIN

Amen Clinics

Loving Someone with ADHD: 12 Common Relationship Challenges

THE EXCITING AND CHALLENGING SIDES OF ADHD IN RELATIONSHIPS

12 COMMON ADHD RELATIONSHIP CHALLENGES

1. Speaking Without Thinking

2. Misperceptions and Communication Breakdowns

3. Interruptions and Distractibility

4. Chronic Procrastination and Disorganization

5. Sensory Sensitivity

6. Excessive or Minimal Talking

7. Risk-taking Behavior

8. Emotional Volatility and Mood Swings

9. Drama-seeking

10. Restlessness and Escapism

11. Difficulty Seeing Other’s Emotional Needs

12. Repeating The Same Arguments Without Resolution

6 Survival Strategies for Partners of ADHD Individuals

1. Be specific with requests.

2. Use reminders and technology tools.

3. Adjust expectations.

4. Set boundaries and enforce them gently.

5. Encourage a brain-healthy lifestyle.

6. Understand their ADHD type.

WHEN TO CONSIDER A BRAIN SCAN OR PROFESSIONAL HELP

FAQ

Amen Clinics

Quiz: Is Your Child’s Anger Out of Control?

ANGER IN A CHILD’S BRAIN

UNDERSTANDING THE ROOTS OF YOUR CHILD’S ANGER

1. Unmet Expectations

2. Communication Challenges

3. Environmental Stressors

4. Developmental Stages

5. Underlying Mental Health Conditions

STRATEGIES TO ADDRESS AND MITIGATE ANGER

1. Encourage open communication.

2. Teach simple coping mechanisms.

3. Establish consistent routines.

4. Model appropriate behavior.

5. Know when to seek professional support.

CHILD ANGER QUIZ

Is your child getting into trouble at school or at risk of being suspended or expelled due to anger, aggression, or fighting?

Is your child a danger to him/herself or to others?

Does your child get excluded from playdates and parties with other children because of problem behavior?

Do your child’s angry outbursts disrupt your home life and cause strife in the family?

Is your child too old to be having temper tantrums and meltdowns, but still having them?

Does your child feel guilty and frustrated because they can’t control their anger?

Amen Clinics

Performance Anxiety: 5 Proven Ways to Overcome It

UNDERSTANDING PERFORMANCE ANXIETY

STRATEGY #1: PRACTICE RELAXATION TECHNIQUES TO OVERCOME PERFORMANCE ANXIETY

How Relaxation Reduces Physical Symptoms of Performance Anxiety

Simple Relaxation Exercises to Incorporate into Your Routine

The Long-Term Benefits of Relaxation for Anxiety Relief

Strategy #2: Build Confidence with Visualization Techniques