I never thought I'd end up in therapy. But I spent three years seeing a therapist who charged $450 per session — and I didn't truly take advantage of his help until the last few months.

At first, I was skeptical. "This is a waste of my time," I said to myself. But I was wrong. What my therapist saw, that I couldn't, was that I was completely burned out. I had given myself an insanely punishing schedule without realizing it.

In my last year of medical school, I spent a month leading trauma clinics in South Africa. Then I decided to go into psychiatry. After my first year, I got to research cultural competency, which meant traveling across the globe to understand how different cultures approached mental health. I had traveled to 30 different countries.

It felt so normal to me to work this hard that I didn't even realize I was risking my health in the process.

Really ask yourself: 'Am I making myself miserable?'

After about five sessions, my therapist looked me in the eyes and said, "We're not supposed to use the term 'masochism' in therapy, but it applies to you, and you need to do something about it."

It was life-changing advice not just personally, but in the way I approached my work as a psychiatrist.

The word "masochism" tends to make my patients uncomfortable. They immediately think of handcuffs and safe words. Masochism, as defined by the Diagnostic and Statistical Manual of Mental Disorders in 1980, is a personality disorder characterized by a pervasive pattern of self-defeating behavior.

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But by 1994, when the next version of our medical bible, the DSM-IV, came out, this definition was nowhere to be found. The editors were concerned it could be seen as victim-blaming, suggesting that people were "choosing" mistreatment and "inciting" hurt and humiliation.

I'm not using the term to blame a victim. I'm using it to help you identify and ultimately let go of self-sabotaging patterns. But to take control of your life and find happiness, you first need to understand the different ways masochism shows up.

1. In your relationships

Masochism can present itself in the form of self-sacrificing behavior, whether with co-workers, friendships or romantic partners.

When you're constantly in people-pleasing mode, you will attract people who take advantage of you in friendships, romantic relationships, or even with family. And if you're giving, other people are going to be taking.

This can manifest in someone taking on all of the household duties, for example, or parenting work in a romantic relationship.

2. In your career

This level of masochism can manifest itself in the quest for advancement or accolades that we think will bring us happiness.

You can see it in any field where employees are overworked and undervalued and still don't feel like they're doing enough. Think about public defenders working for no pay to represent the people who need them the most. Or journalists reporting from war-torn countries, risking their lives to deliver truth to the world. Or agricultural workers, non-profit employees or people in the military.

It can even be the entry-level employee at the finance firm who gets stuck with 80-hour workweeks and sacrifices any semblance of a social life for the dream of someday making it to the corner office.

How to break the cycle

The good news is that masochism isn't destiny — it's a choice, and you can always choose differently once you recognize the patterns holding you back.

1. Listen to your body

You might notice that your heart is beating a little faster because you've been downing coffee all day in order to keep up with work, and you're over-caffeinated.

I tell my friends that if my nails are chipped, that's a sure sign I'm burned out and need to slow down for some self-care.

2. Listen to your friends

Sometimes the sacrifices we make force others in our lives (like our lovers, friends, co-workers, neighbors or kids) to make sacrifices as well.

I take cues from my team, my friends and even my daughter. If they're hinting that a project timeline is too ambitious or I've been staring at my emails all night instead of paying attention to them, I don't brush it off. I take it seriously and change my behavior.

3. Listen to your heart

Take a pause before you say "yes" or "no" to a task, and ask yourself if you really want to do it. Very often, there's a small voice inside of us that realizes we're too burned out to work all weekend or that we don't want to do our partner's laundry today.

That favor you twist yourself into a pretzel to execute may go unnoticed by the other person, and ultimately it doesn't increase your value or your worth — two things you already have without needing to do anything.

Judith Joseph, MD, MBA, is a board-certified child, adolescent, and adult psychiatrist and researcher who specializes in mental health and trauma. She is the author of "High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy."

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Adapted excerpt from "HIGH FUNCTIONING" by Dr. Judith Joseph. Copyright © 2025 by Dr. Judith Joseph MD MBA PC. Used with permission from Little, Brown Spark, an imprint of Hachette Book Group.