Perfectionism is a much discussed topic these days, with many books, articles, videos, and podcasts on the topic. Some of it is helpful, others not so much. One aspect of perfectionism I rarely see talked about are the different types of perfectionistic tendencies and what motivates this drive to be perfect. To start, it is important to identify what type of perfectionist you might be.  

Perfectionism is a broad term for a wide-ranging set of beliefs and actions. On one end there are perfectionists that never miss a deadline, look and act very put together, and are the ones who complete any assignments (or work tasks) as soon as they get them. On the other end are the people with perfectionistic tendencies who avoid, procrastinate until the last minute, or get lost in the planning or research phase that they do not ever finish what they start (or do so under intense pressure – often last minute). Regardless of the kind of perfectionistic tendencies a person has, there is usually at the root of perfectionism, a strong fear of failure and a tendency to be very self-critical. What differentiates the perfectionism is the motivations underlying the perfectionistic-beliefs and actions that reinforce the perfection. 

The 2-Types of Perfectionism: Motivations and Behaviours

The 2-types of perfectionism I will focus on are self-oriented and socially-prescribed. Self-Oriented Perfectionism, which is thought of as involving a set of high, unrelenting, and unrealistic standards that a person sets for themselves. People who tend to be more self-oriented in nature may be very aware of their self-critical thoughts, and judge themselves harshly, and use this as motivation (and sometimes punishment). People who are self-oriented perfectionists tend to be goal oriented, set unrealistic targets for their performance, and are strongly afraid of failing their own ambitions. 

The second type, Socially-Prescribed Perfectionism, may involve those who have high, unrealistic, and unrelenting expectations, but these expectations come from others (rightly or wrongly) and are designed to try and keep others happy. For example, people high in socially-prescribed perfectionism may work hard to take care of others, win the approval of others, and are often very concerned with how others see them (ideally in a perfect way). 

Socially-prescribed differs from self-oriented perfectionism in that beliefs and demands for perfection start with others expectations (think of a parent demanding to know what happened to that last 5% on a test), but become directed inwards towards ourselves. In other words, socially-prescribed are perfectionistic demands that are outside -> in; self-oriented are demands that are inside->out. 

It’s not always easy to figure out what type of perfectionist category we fall into. In many cases we can be concerned with both what others think or our own goals. Sometimes, our expectations depend on the environment we are in and who is around us. We all act differently at work than we do out a dinner later with friends. Here’s a way I’ve found helpful to get at the issue of what kind of perfectionist you might be: 

Ask yourself this:  

“Who would you rather disappoint: Yourself or someone else (e.g., your boss, your employees, your parents, your friends, your kids, your spouse, etc.).”

Take your time, the first option that comes to mind is often the more accurate one. Pay attention to see if one option raises your anxiety more than the other. You might be ok disappointing your friends or a manager, but become upset or tense at the idea of not meeting a goal you set yourself (in this case you’d be higher on self-oriented perfectionism).

The main message is that perfectionism comes in different forms and flavours, largely depending on where our expectations come from (inside vs. outside ourselves). This also means that the expectations around perfectionism, regardless of the source, put immense pressure on us to be perfect. Unfortunately, perfection is not something that is truly attainable, which is why perfectionism is highly self-defeating. When we push ourselves to extremes to try to achieve something that is impossible, we end up with failure. Setting our expectations more compassionately and our goals more realistically and shifting our focus to the process not the outcome helps reduce the pressures of perfection.   

Dr. Robert Hill, C.Psych. is a clinical and health psychologist at the Centre for Interpersonal Relationships. He provides psychotherapy for adults experiencing a wide range of mental health symptoms, including perfectionism. 

References:

Hewitt, P. L., & Flett, G. L. (2002). Perfectionism and stress processes in psychopathology. In G. L. Flett & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp. 255–284). American Psychological Association. https://doi.org/10.1037/10458-011

In part 1 of this blog series, we saw the challenge of expressing emotions and the shame that can come with it – and how it can impact relationships. Shame doesn’t just silence emotions. It disconnects us from our own needs and from those we love. When we feel shame, we’re less likely to voice our emotional experience. This can make it harder for our partners to understand us or respond to what we truly need. Over time, this can create distance and misattunement in the relationship, even when both people care deeply about one another. Naming shame is the first step toward healing and reconnection.

The first step towards de-shaming emotional experiences is normalizing them. It’s okay to

• feel unsure about what you’re feeling
• need help in naming and expressing emotions
• find certain emotions, like anger or sadness, uncomfortable or even frightening

The goal is not to eliminate difficult emotions. Rather, we want to develop a new relationship with them. One that allows you to recognize, understand, and respond to them in more helpful ways, that bring growth and connection.

What does this mean for couples or individuals? It means creating space for emotions without judgment. Listening to your own/each other’s feelings with curiosity and compassion rather than defensiveness. Replacing criticism with understanding and recognizing that behind every strong emotion is a longing to be seen, heard, valued.

By shifting from shame to self-compassion, couples and individuals can break free from emotional disconnection. The more we learn to identify and express our emotions, the more we can meet our own needs as well as those of our partners. Emotional fluency is not an innate language. It is learned, practiced, and developed over time. Just like any other language! And no matter where you are in your emotional journey, it’s never too late to begin.

Mental health services can provide the tools, space, and support for this process. In therapy, individuals and couples can safely explore their emotional world with the guidance of a therapist. Therapy offers a space to practice identifying feelings, unpack the needs behind them, and work through the shame that may have built up around emotional expression. With time and support, clients can begin to rewrite the narratives they hold about emotions, learn how to respond to each other with empathy, and deepen their emotional connection in lasting ways.

Daniela Levi, MSW, MEd, is a Registered Psychotherapist at CFIR, specializing in individuals, couple and family therapy. Her work focuses on self-awareness and strengthening interpersonal relationships through an attachment-based and emotion-focused approach. With a deep passion for the role of emotions in relational dynamics, Daniela helps clients navigate their inner experiences to build deeper connections with themselves and others. She is currently pursuing her Doctorate in Psychology at the University of Toronto. 

One of the most common struggles I see in couples therapy is the difficulty one or both partners have in identifying and expressing their own emotions. Many people grow up without ever learning how to name or understand their feelings. Emotions are internal signals – our mind and body’s way of letting us know that something important is happening within or around us. They help us make sense of our experiences, guiding our attention to what matters, motivating us to act. In school, we are taught math, science, and history, but rarely are we given the tools to navigate our inner emotional experiences. As a result, emotions can feel foreign, overwhelming, or even scary and dangerous.

Every emotion has a need attached to it. Sadness might signal a need for comfort or connection. Anxiety could be pointing to a need for reassurance or safety. Anger often shows up when a boundary has been crossed, indicating a need for respect or acknowledgment. Yet, when emotions remain unrecognized, so do the needs behind them. This can leave individuals and couples stuck – feeling misunderstood, unheard, and disconnected. 

Barriers to expressing emotions and meeting relational needs

One of the greatest barriers to emotional awareness and growth is shame. Many people have been taught (either directly or indirectly) that emotions are a sign of weakness or irrationality. This is especially true for emotions like anger, which can be labeled as “bad” or “destructive,”. Vulnerability can be seen as something to suppress and hide. The fear of being judged (by oneself or others) can keep us from exploring our emotions with curiosity and compassion. Struggling with emotions is not a personal failure -it’s more common than we realize, and an aspect I often see in my work. If we were never taught how to identify, name and process our feelings, how could we be expected to do so with ease? There is no shame in finding emotions confusing or intimidating. In fact, recognizing this struggle is the first step toward change.

In part 2 of this blog series, we will explore the steps we can take to start de-shaming being in touch with our own emotions, paving the way to more vulnerability and connection with our partner.

 Daniela Levi, MSW, MEd, is a Registered Psychotherapist at CFIR, specializing in individuals, couple and family therapy. Her work focuses on self-awareness and strengthening interpersonal relationships through an attachment-based and emotion-focused approach. With a deep passion for the role of emotions in relational dynamics, Daniela helps clients navigate their inner experiences to build deeper connections with themselves and others. She is currently pursuing her Doctorate in Psychology at the University of Toronto. 

In Part 1 of this blog, we explored how complex trauma affects a person emotionally, cognitively, and physically, often leading to complex post-traumatic stress disorder (C-PTSD). In this next section, we’ll focus on the long-term effects of complex trauma and discuss ways to begin the healing process.

Complex trauma refers to prolonged, repeated exposure to traumatic events, often occurring within interpersonal relationships or early in life. Unlike single-incident trauma, complex trauma shapes a person’s sense of identity, safety, trust in themselves and the world, and general attachment to others. Understanding these impacts is the first step toward compassionate, effective care and meaningful recovery.

The Long-Term Impact of Complex Trauma

Without intervention, complex trauma can shape a person’s personality, behaviors, and overall mental health. Many individuals develop anxiety disorders, depression, or dissociative disorders as a result of their experiences. They may struggle to maintain stable jobs, relationships, and a sense of purpose in life. Self-destructive behaviors, including substance abuse, disordered eating, or reckless decision-making, can become coping mechanisms for the unresolved pain/hurt. Additionally, chronic feelings of emptiness, emotional detachment, and difficulty trusting others can make it challenging to build a fulfilling life. However, despite these challenges, healing is possible with the right support and strategies.

Healing from Complex Trauma

Recovery from complex trauma is a gradual process that requires patience, support, and intentional effort. When beginning the journey, it is important to establish a sense of safety and stability in your life. Before deep healing can occur, individuals must feel physically and emotionally secure in their environment. This includes developing healthy routines, learning self-soothing techniques, and building supportive relationships. 

Psychotherapy can also be helpful in determining the specific messaging that led to the complex trauma. After having a better understanding of the ways we were hurt, we then have the opportunity to develop new, more helpful narratives about ourselves and the world around us that makes us feel safe and secure. Additionally, psychotherapy can also be a space where you learn to recognize triggers, establish boundaries, and emotionally regulate when feeling heightened. 

Dr. Erica Tatham, Ph.D., C. Psych., is a psychologist and neuropsychologist at the Centre for Interpersonal Relationships (CFIR). Dr. Tatham provides psychological services to individual adults and seniors experiencing a wide range of psychological and relationship difficulties. She typically works with individuals experiencing mood and anxiety disorders, complex and situational trauma, neurodevelopmental disorders (e.g., ADHD and ASD), and interpersonal conflict. She takes an integrative approach to therapy and utilizes emotion focused therapy (EFT), object relations and self-psychology, and cognitive behavioural therapy (CBT).

References:

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., & Van der Kolk, B. (2005). Complex trauma. Psychiatric annals, 35(5), 390-398.

Ford, J. D., & Courtois, C. A. (Eds.). (2020). Treating complex traumatic stress disorders in adults (2nd ed.): Scientific foundations and therapeutic models. New York: The Guilford Press.

Trauma is often thought of as a single, life-altering event, but for many people, it is an ongoing experience that shapes their entire sense of self and the world around them. Complex trauma develops from prolonged exposure to distressing events, often in relationships where there is an expectation of safety and care, such as in the home or with caregivers. Unlike single-incident trauma, which may result from a car accident or a natural disaster, complex trauma is deeply woven into a person’s development and disrupts emotional regulation, trust, and a person’s sense of self. Understanding complex trauma is essential, both for those who experience it and for those who support them on the path to healing.

The Impact of Complex Trauma

The effects of complex trauma extend beyond emotional distress, influencing cognitive functions, physical health, and interpersonal relationships. 

Emotionally, individuals may struggle with intense mood swings, difficulty regulating emotions, and persistent anxiety or depression. Many people with complex trauma experience chronic feelings of emptiness, shame, or guilt, often engaging in self-destructive behaviors such as substance abuse or self-harm as a way to cope. 

Cognitively, trauma can impair concentration, memory, and decision-making. Many individuals report experiencing intrusive thoughts or flashbacks and develop a negative self-perception, feeling inherently flawed or unworthy of love. These thought patterns often lead to overgeneralized fear responses, where a person expects harm even in safe situations. 

Physically, the body carries the weight of trauma, manifesting in symptoms such as chronic fatigue, muscle tension, gastrointestinal issues, and an overactive stress response. Sleep disturbances, including nightmares and insomnia, are also common. The nervous system remains on high alert, leading to hypervigilance and difficulty relaxing, even in non-threatening environments.

Complex PTSD (C-PTSD) vs. PTSD

When the trauma experiences cause significant psychological distress, then an individual will likely be diagnosed with post-traumatic stress disorder (PTSD). 

While both PTSD and Complex PTSD (C-PTSD) result from trauma, they differ in key ways. PTSD typically develops after a single, identifiable traumatic event and is characterized by flashbacks, nightmares, and heightened arousal. In contrast, C-PTSD emerges from repeated trauma over time and therefore makes emotional dysregulation, a distorted self-image, and chronic difficulties in relationships more likely. 

Although C-PTSD is not yet formally recognized as a separate distinct diagnosis in all diagnostic systems, it is widely acknowledged in trauma-informed care and therapeutic settings.

Dr. Erica Tatham, Ph.D., C. Psych., is a psychologist and neuropsychologist at the Centre for Interpersonal Relationships (CFIR). Dr. Tatham provides psychological services to individual adults and seniors experiencing a wide range of psychological and relationship difficulties. She typically works with individuals experiencing mood and anxiety disorders, complex and situational trauma, neurodevelopmental disorders (e.g., ADHD and ASD), and interpersonal conflict. She takes an integrative approach to therapy and utilizes emotion focused therapy (EFT), object relations and self-psychology, and cognitive behavioural therapy (CBT).

References:

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., & Van der Kolk, B. (2005). Complex trauma. Psychiatric annals, 35(5), 390-398.

Maercker, A., Cloitre, M., Bachem, R., Schlumpf, Y. R., Khoury, B., Hitchcock, C., … & Bohus, M. (2022). Complex post-traumatic stress disorder. The lancet, 400(10345), 60-72.

By Laura Moore MPsy.

You know that moment—when you walk away from a conversation with a lump in your throat, your chest tight, your jaw locked, and your inner voice screaming, “Why didn’t I just say it?” That’s self-silencing. And whether it shows up as a forced smile, a nod you don’t mean, or biting your tongue again—it’s not just frustrating. It’s exhausting.

Here’s the truth: we self-silence because we’re trying to stay safe. Somewhere along the way, we learned that speaking up might get us criticized, rejected, or even abandoned. So we played small. We became the easy one, the chill one, the don’t-make-it-a-big-deal one.

But let me be clear: that silence comes at a cost.

When we mute our truth, our relationships suffer. We crave closeness, but we keep hiding the very parts of us that would create it. We resent others for not meeting needs we never voiced. And at work? We play it safe, stay in the background, and wonder why we feel invisible.

Spoiler: you can’t be seen when you’re constantly shrinking.

So what do we do?

We get honest. Ask yourself: What am I afraid will happen if I speak up? And what’s already happening because I don’t? Don’t just brush past that question—sit with it.

Then try this: one act of micro-bravery a day. Say one true thing. Out loud. Even if your voice shakes. Even if your hands do too, truth builds trust—not just with others, but with yourself.

And here’s what matters most: self-validation. You’re not waiting for someone else to say it’s okay to speak—you get to say that to yourself. That voice you once silenced to stay safe? It’s time to meet it with compassion. You can be the one now who says, “I hear you.” That’s how we begin to build a home inside ourselves where truth is welcome.

You weren’t put on this planet to blend in. You were made to be seen, heard, and known.

It’s time to stop trading authenticity for approval.

Speak up.

Show up.

The real you is not too much—it’s just been waiting for permission.

And here’s the secret: you don’t need it. You are the one who gets to give it!

Laura Moore, MPsy., is an integrative therapist at the Centre for Interpersonal Relationships (CFIR) in Toronto, specializing in helping individuals and couples navigate the emotional complexities of fertility, identity, and intimate relationships. With a deep understanding of how early patterns of self-silencing, perfectionism, and people-pleasing impact adult connection, Laura creates a safe, nonjudgmental space to explore grief, loss, relational boundaries, and self-worth. She supports clients through transitions such as fertility treatments, separation, infidelity, and rebuilding after emotional trauma. Laura is passionate about helping people reclaim their voice, deepen self-trust, and cultivate relationships that honour both authenticity and connection.

Regulation refers to how we manage emotions and employ behaviours in the pursuit of goals, wellness, and sense of safety (Paley & Hajal, 2022). How we regulate may be in our conscious awareness or not, and can impact overall wellbeing, relationships, and decision making. There are more or less healthy ways to regulate and, like all ways of coping, none are by default categorically adaptive or not (Eisenstadt, Liverpool, Infanti, Ciuvat, & Carlsson, 2021). Sometimes, avoiding a stressor is the healthiest thing to do (for example, spotting a bear in a forest). Others, avoiding can further exacerbate distress (for example, not discussing a problem that’s been gnawing away at you at work). It really depends on the circumstance. 

Healthy functioning involves the ability to effectively self-regulate and co-regulate in order to have a sense of self-efficacy, navigate life’s stressful events, and maintain (intimate) relationships (Panayiotou, Panteli, & Leonidou, 2021). What do these two terms mean? 

Self-regulation refers to what we do to exert control over our emotions or behaviours on our own (Rosanbalm & Murray, 2017). Some healthier forms of self-regulation can include crying, exercising, sleeping, journaling, intentional breathing, and connecting with nature. Some less healthy forms of self-regulation can include impulsive spending, consumption of drugs, overeating, and skin picking. 

Co-regulation refers to what we do to exert control over our emotions or behaviours with another (Rosanbalm & Murray, 2017). Some examples of healthier co-regulation can include venting to a friend, speaking with a therapist, participating in a group yoga class, cuddling a partner, and even petting your pet. 

You might be wondering, what does a healthy balance of self- and co-regulation look like for me? 

As with most things in life, context is important. When I meet with clients, I am careful to explore whether efforts to regulate are coming from a healthy place or not (e.g., reflect their values, who they want to be, secure attachment (see my previous Blog on Attachment); whether there may be avoidance of a deeper problem; or when they may be causing themselves harm. That said, an overreliance on self-regulation may look like self-isolation or shutting out a partner. Unhealthy co-regulation may look like an overreliance on others for validation or advice, risky sexual behaviours, or explosive conflicts. 

It is also important to me to understand the origin story of these self- and co-regulating efforts. Where might you have learned to regulate the way you do? How has this served you, even initially, in the past? How is this way of being not serving you now? 

For those struggling with achieving an effective balance between the two, there is help. As a clinical psychologist, I ultimately try to help clients determine an optimal balance between self- and co-regulation. Together we can identify more effective regulating strategies that, through practice, eventually become habits toward a more fulfilling lifestyle. 

References

Eisenstadt, M., Liverpool, S., Infanti, E., Ciuvat, R. M., & Carlsson, C. (2021). Mobile apps that promote emotion regulation, positive mental health, and well-being in the general population: Systematic review and meta-analysis. JMIR Mental Health, 8(11), doi:10.2196/31170

Paley, B., & Hajal, N.J. (2022). Conceptualizing emotion regulation and coregulation as family-level phenomena. Clinical Child and Family Psychology Review, 25, 19–43. https://doi.org/10.1007/s10567-022-00378-4

Panayiotou, G., Panteli, M., & Leonidou, C. (2021). Coping with the invisible enemy: The role of emotion regulation and awareness in quality of life during the COVID-19 pandemic. Journal of Contextual Behavioral Science, 19, 17-27. https://doi.org/10.1016/j.jcbs.2020.11.002

Rosanbalm, K. D., & Murray, D. W. (2017). Caregiver co-regulation across development: A practice brief. OPRE Brief #2017-80. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, US. Department of Health and Human Services. 

Dr. Sara Antunes-Alves, C.Psych. is a psychologist in private practice who particularly enjoys working with individuals struggling with their sense of self, interpersonal relationships, and emotion regulation – especially as they are impacted by complex attachment-related trauma and family of origin issues. As a keen scientist-practitioner, she is passionate about research, and has published and served on review boards in the areas of psychopathology, its impact on functioning, and the ingredients of effective therapy. Prior to entering private practice full time, she enjoyed running a mental health program for at-risk students and serving as Adjunct Research Professor in Psychology at Carleton University, where she conducted assessments, psychotherapy, supervision, and outcome-based research on the efficacy of mental health programs. At CFIR, she also supports the professional development of psychologists-in-training by providing clinical supervision.  

Gaining awareness of attachment dynamics can empower individuals with rare diseases to enhance their emotional and relational well-being. The following strategies can help them cultivate healthier relationships and improve their psychological resilience. 

1. Recognize Emotional Responses 

Cultivating self-awareness about emotional responses is vital. Understanding how attachment styles influence reactions can help patients navigate relationships more effectively. For instance, recognizing anxious behaviors can prompt patients to communicate their needs openly rather than relying on others to intuit them. 

2. Communicate Openly 

Clear communication is critical in mitigating misunderstandings rooted in attachment dynamics. Patients should express their feelings using “I” statements to foster understanding and reduce defensiveness in conversations. For example, saying, “I feel anxious when my symptoms flare up, and I need you to listen” can clarify needs without placing blame. 

3. Seek Support Networks 

Engaging with support networks can alleviate feelings of isolation. Sharing experiences with others who understand the challenges of living with a rare disease can reinforce a sense of belonging and mitigate the effects of insecure attachments. 

4. Establish Boundaries 

Setting healthy boundaries is crucial for both patients and caregivers. Clients should recognize when emotional demands become overwhelming and communicate these limits to others, fostering healthier relational dynamics. 

5. Practice Self-Compassion 

Cultivating self-compassion is essential for emotional resilience. Recognizing that struggles are valid and allowing space for grief over lost normalcy can promote healing and self-acceptance. This practice can also counteract the negative self-talk often associated with insecure attachment styles. 

6. Embrace Narrative Flexibility 

Patients can benefit from reframing their narratives to focus on resilience and growth. Acknowledging challenges while also recognizing strengths can shift perspectives and enhance emotional well-being. 

7. Seek Professional Support 

Clients are encouraged to seek professional support tailored to their unique experiences. Mental health professionals can provide insights into attachment dynamics, helping individuals navigate their relationships and develop healthier coping strategies. Therapy can also help address cognitive distortions and enhance emotional regulation skills. 

The interplay between attachment theory, the complexities of rare diseases, and the psychological dynamics at play illustrates how attachment styles profoundly influence emotional and relational well-being. By understanding how their attachment dynamics shape their experiences, individuals can enhance their emotional resilience and foster healthier relationships. Ultimately, these considerations, combined with professional support, can lead to improved mental health outcomes and a more fulfilling life, despite the challenges posed by rare diseases. 

Iguaraya (Igua) Morales, Psychological Associate (Supervised Practice), is a bilingual psychologist (English and Spanish) with over 30 years of experience. She provides psychological services to adults, families, and communities, addressing challenges such as behavioral issues, emotional regulation, and psychosocial difficulties. Iguaraya uses an integrative approach, combining Humanistic (Person-Centered, Emotion-Focused) and Cognitive-Behavioral techniques, tailored to the unique needs of her clients. She also incorporates mindfulness and yoga practices to promote holistic well-being. In addition to her clinical work, Iguaraya Morales has a distinguished career as a professor, mentoring students and professionals in psychology and research. Based in Ontario, she is registered with the College of Psychologists of Ontario. 

References 

Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Erlbaum. 

Bowlby, J. (1982). Attachment and loss: Vol. 1. Attachment (2nd ed.). Basic Books. 

Understanding the psychological dynamics at play can provide deeper insights into how attachment styles manifest in the context of rare diseases. By examining these patterns, individuals can take proactive steps to strengthen their emotional and relational well-being. 

Emotional Regulation 

Individuals with secure attachments typically possess better emotional regulation skills, which enable them to cope with the stress of chronic illness. In contrast, those with insecure attachments may struggle to manage their emotions, leading to heightened anxiety, depression, or anger. This emotional dysregulation can negatively affect their relationships, as they may react disproportionately to perceived threats or misunderstandings. 

Fear of Intimacy and Trust Issues 

Patients with avoidant attachment styles may have difficulty trusting others and fear intimacy, leading to a reluctance to seek help or share their experiences. This fear can prevent them from forming meaningful connections and hinder their ability to communicate needs effectively, creating a cycle of isolation and emotional distress. 

Cognitive Distortions 

Insecurely attached individuals may be prone to cognitive distortions, such as catastrophizing or black-and-white thinking. For example, they might view a partner’s inability to understand their illness as a personal rejection rather than recognizing it as a limitation of the partner’s understanding. These distorted perceptions can fuel conflict and deepen relational rifts. 

How Therapy Can Help 

Therapy can be instrumental in identifying and restructuring maladaptive thought patterns and emotional responses. By working with a therapist, individuals can: 

• Develop healthier coping strategies to manage emotional dysregulation. 
• Challenge cognitive distortions and reframe negative thought patterns. 
• Build trust and intimacy in relationships by addressing attachment-related fears. 
• Strengthen communication skills to express needs and emotions more effectively. 

Iguaraya (Igua) Morales, Psychological Associate (Supervised Practice), is a bilingual psychologist (English and Spanish) with over 30 years of experience. She provides psychological services to adults, families, and communities, addressing challenges such as behavioral issues, emotional regulation, and psychosocial difficulties. Iguaraya uses an integrative approach, combining Humanistic (Person-Centered, Emotion-Focused) and Cognitive-Behavioral techniques, tailored to the unique needs of her clients. She also incorporates mindfulness and yoga practices to promote holistic well-being. In addition to her clinical work, Iguaraya Morales has a distinguished career as a professor, mentoring students and professionals in psychology and research. Based in Ontario, she is registered with the College of Psychologists of Ontario. 

Attachment theory, developed by John Bowlby and Mary Ainsworth, posits that the quality of early caregiver relationships profoundly influences an individual’s emotional and social development. Secure attachments promote emotional regulation and resilience, while insecure attachments characterized by anxiety, avoidance, or ambivalence can impair relational functioning and emotional well-being (Bowlby, 1982; Ainsworth et al., 1978). Understanding these dynamics is crucial for individuals facing the challenges of rare diseases, as their experiences may shape and reinforce particular attachment patterns in significant ways. 

The Unique Challenges of Rare Diseases 

Individuals diagnosed with rare diseases encounter specific challenges that can significantly influence their attachment styles and relational dynamics. These challenges often stem from the uncertainty, social impact, and caregiver relationships that accompany their condition. Below are some of the key ways in which rare diseases may interact with attachment dynamics: 

1. Chronic Uncertainty and Anxiety 

The unpredictable nature of rare diseases often leads to chronic anxiety. Patients may develop an anxious attachment style, marked by hyper-vigilance and a constant fear of abandonment. This anxiety can manifest in relationships as a heightened need for reassurance or an over-dependence on caregivers, leading to a cycle of anxiety and relational strain. 

2. Social Isolation and Stigmatization 

Many individuals with rare diseases experience profound social isolation due to a lack of understanding from others. This social withdrawal can reinforce an avoidant attachment style, where patients may distance themselves emotionally or physically from others to protect their feelings. This avoidance can create barriers to building and maintaining supportive relationships, further exacerbating feelings of loneliness and unworthiness.

3. Caregiver Dynamics and Attachment Disruptions 

The emotional toll on caregivers can create complex relational dynamics. Caregivers may experience burnout, leading to either enmeshment (where boundaries become blurred) or emotional withdrawal. For instance, a caregiver may become overly involved, inadvertently fostering dependency and inhibiting the patient’s autonomy. Alternatively, if the caregiver withdraws emotionally due to their own distress, the patient may feel abandoned, reinforcing insecure attachment behaviors. 

The Role of Therapy in Addressing These Challenges 

Therapeutic interventions can help individuals with rare diseases recognize and address attachment-related challenges. Therapy provides a safe space to explore relational patterns, develop healthier coping mechanisms, and foster emotional resilience. Through approaches such as Emotion-Focused Therapy (EFT), Cognitive-Behavioral Therapy (CBT), and mindfulness-based practices, individuals can work toward: 

• Identifying attachment patterns and their impact on relationships.
• Developing secure relational strategies to navigate uncertainty and social isolation. 
• Enhancing communication skills to express needs effectively. 
• Supporting caregivers in setting healthy boundaries while maintaining emotional connection. 

Iguaraya (Igua) Morales, Psychological Associate (Supervised Practice), is a bilingual psychologist (English and Spanish) with over 30 years of experience. She provides psychological services to adults, families, and communities, addressing challenges such as behavioral issues, emotional regulation, and psychosocial difficulties. Iguaraya uses an integrative approach, combining Humanistic (Person-Centered, Emotion-Focused) and Cognitive-Behavioral techniques, tailored to the unique needs of her clients. She also incorporates mindfulness and yoga practices to promote holistic well-being. In addition to her clinical work, Iguaraya Morales has a distinguished career as a professor, mentoring students and professionals in psychology and research. Based in Ontario, she is registered with the College of Psychologists of Ontario.