Common Social Barriers

The excerpt below is from The Duchenne Life, our weekly livestream with DJ Kimble and Ryan Russell. Thank you to psychologist Dr. Natalie Truba of Nationwide Children’s Hospital for being our guest on this episode. Click here for the podcast.

Common Social Barriers in Adult Relationships

DJ Kimble: Natalie, could you please speak a little about the key skills that are needed in building relationships and which of the comorbidities associated with Duchenne present the biggest barriers in building those relationships?

Dr. Natalie Truba: To begin – and you may have heard this before – if you meet one person with DMD then you’ve met one person DMD. Not everyone with DMD will have the same barriers. The biggest barriers are probably going to be pretty unique or ideographic to each of you as an individual, depending on what it is that you struggle with, or where you find it easier to be uncomfortable, right? So, it’s essential to keep that in mind.

But if I had to brush this topic with a broad stroke – so to say – about the key skills that are needed in building relationships and which of the comorbidities associated with Duchenne present the biggest barriers in building those relationships, I would do it like this: rigidity of thought and unwillingness to be uncomfortable.

The Skills Needed for Relationships

I think the skills that are most important for relationships are the same whether you have Duchenne or not: a willingness to learn, to be open to experience and growth, and to receiving feedback. Allowing yourself the opportunity to be uncomfortable so you can develop more comfort. Also, a willingness to be vulnerable.

With Duchenne, I don’t think any of those things are impossible, but it looks a little different because the vulnerabilities are different. DMD often has cognitive themes of anxiety, rigidity, the inability to be flexible and how we think about the world.

Rigidity & Inflexibility in Thought

So, again, I think rigidity is one of the biggest barriers in developing and or having relationships where both people feel good in the relationship.

When you’re really rigid and inflexible – as many individuals with Duchenne are – other people are often doing most of the accommodating. They are often sacrificing so much to keep you happy and to try to meet you where you’re at, but that doesn’t always feel like a fulfilling relationship for the person doing most of the accomodating.

I think that the rigidity of thought contributes to maybe less robust relationships than many people want or are hoping for.

Anxiety & New Situations

It’s important to briefly discuss something we call “response effort.” We can either put in a great deal of response effort, or just a little. Let’s consider both when it comes to building relationships.

More response effort means we have to put in a little bit of effort to do well and what we know about humans is that this is where we kind of learn our best. We do our best here and we perform our best here, too.

On the other hand, when humans get uncomfortable, we often choose the easier route. We call it the “lowest response effort” and humans are just gonna take the path of least response effort during discomfort. That’s just how we are.

So, when we’re doing the least effort, then we’re not going so much out of our comfort zone. Low response effort might be like “I only socialize with people online, and only the people I play the video games with, and only when they play the video games that I like.” So, in this example, socializing with people in the context of only doing things “that I like” would be choosing the lowest response effort, right?

Well, it’s going to be really hard to meet people if that’s the only way that you’re allowing yourself to socialize with people. It’s a really limited world then, because now you’re limiting yourself to one particular game and only people that like that game and want to play it the way you wanna play it. I don’t know if there’s a ton of women doing that – I’m gonna guess no – but maybe there are some. But that still makes the dating pool limited.

You can have very meaningful relationships online – don’t get me wrong – but there is a different type of connection that happens when you’re with people in the same proximity.

So I think that anxiety piece really gets in our way of allowing ourselves to be in novel situations where we would be exposed to developing the skill sets we need to develop more meaningful relationships… like talking to people in person and navigating and using different skills (like humor and thinking on your feet and cognitive flexibility) to form richer relationships and get to know people over a shared experience or a hobby or something that you have in common in real life. In person interaction helps make those connections between humans so much stronger


When you guys, when we’re really anxious and we feel stuck and we’re not willing to expose ourselves, allow ourselves to feel uncomfortable, put ourselves in new situations, allow ourselves to feel that anxiety – then we’re very limited. I think that’s a big barrier to allowing ourselves to take a risk with new experiences, which is necessary in creating new relationships. I think it’s an unwillingness to be vulnerable and to feel uncomfortable that prevents us from gaining a new experience.

But it doesn’t have to be that way. Even small changes can lead to big results.

Maybe consider creating relationships that aren’t just aimed at a sexual outcome. There’s a real benefit to learning things from other people including people of the opposite gender or gender identity. There’s a benefit in developing friendships with a variety of gender identities – not just those you are sexually attracted to. There’s a benefit to practicing calming the anxiety, becoming more flexible and being open to more vulnerable situations. There’s a benefit to human relationships.