The Hidden Toll of People-Pleasing: Understanding Its Neurocognitive Effects and Adopting Healthy Boundary-Setting Strategies
- Renaldo Pool, BHSc
- Oct 15
- 19 min read
Discover how to prioritize your physical and mental well-being through various therapeutic approaches, including setting healthy boundaries.
Introduction
We have all been in situations, either socially or professionally, where we tend to prioritize others’ emotional needs and wants, along with seeking their approval, over our own well-being. Although extending a helping hand or prioritizing others’ needs over your own is not inherently a bad thing, it can become problematic over time when it affects your mental, emotional, and physical health. The complexities of this, at times, habitual behavior – referred to as people pleasing - are tied to different psychological and neurological mechanisms, which could have negative consequences in the long run.
Although current research has examined various aspects of cognition on prosocial behavior and altruism, the long-term impact of people-pleasing on brain structure and function remains unexplored. Approaching this on a multidisciplinary level can elaborate on various aspects of sociology, social psychology, and neuroscience.
Here, the various psychological theories and long-term neurological effects of people-pleasing are examined, offering practical, real-world strategies to break this habit. These strategies include therapeutic techniques that help establish boundaries, uphold your self-identity, and focus on your emotional and mental well-being.
Key Concepts Discussed
The concept of people-pleasing stems from an emotional need, fear, anxiety, and unhealthy attachment styles.
Various factors contribute to the development of this behavior, including familial and cultural beliefs, insecure attachment styles, trauma, and fear of rejection.
Long-term people pleasing affects cognition through altered executive function, decision-making capabilities, and attunement with your wants and emotions. Furthermore, different brain regions are impacted by chronic people-pleasing, including the amygdala and the prefrontal cortex.
Over time, it could lead to the development of more serious neurological disorders, such as anxiety, depression, emotional exhaustion, and burnout, alongside physical health consequences due to prolonged stress.
With various therapeutic techniques at our disposal, we can target and rewire dysregulated brain pathways, thereby creating healthy boundaries and cultivating self-worth.
Table of Contents
What is People Pleasing?
The behavioral characteristic of people-pleasing is highlighted by the notion of prioritizing others’ needs, emotions, and happiness over one's own mental and physical well-being (Sari & Komarudin, 2024b; Georgescu & Bodislav, 2025; Kuang et al., 2025). People pleasing is often mistaken for an individual exhibiting empathy and kindness, but it arises from a place of emotional need, unhealthy attachment styles, anxiety, and fear (Li, 2022; Kuang et al., 2025). This is rooted in the individual’s need to be liked, accompanied by seeking approval and acceptance from others. They tend to say yes to requests, despite the weight of the decision weighing heavily on them (Li, 2022; Georgescu & Bodislav, 2025).
This could be due to various factors, such as being at full capacity or not being mentally fit to achieve this. However, they follow through with the request by avoiding the anticipated conflict and disappointment that they would potentially experience if they said no (Li, 2022). These individuals also tend to lose their identity in the long run by suppressing their opinions and preferences (Kuang et al., 2025).
How Does People Pleasing Differ from Prosocial Behavior and Sociotropy?
Ever been in the supermarket and noticed someone reaching for a product on the top shelf, only to accidentally knock the lower shelf products to the floor? You instinctively rush over and immediately begin picking the products off the floor and placing them back on the shelf. This is characteristic of prosocial behavior, where an individual (the helper) comes to the aid of another person (the recipient) who is experiencing distress or even emotional discomfort (Olivo et al., 2021; Wu & Hong, 2022). The helper in this situation exhibits caring, compassionate, and empathetic behavior, without feeling the need to benefit from the caregiving action toward the other individual (Olivo et al., 2021; Wu & Hong, 2022).
Whereas sociotropy is a personality trait that is characterized by an individual’s interpersonal need for social acceptance and relies heavily on external validation of their worth and self-esteem from others (Martinez et al., 2020). Individuals with the sociotropic trait also exhibit a fear of abandonment or rejection. Although it does sound similar to people-pleasing, people-pleasing is a maladaptive behavioral pattern that is cultivated, as mentioned earlier.
How can I tell if I have a tendency to people-please?
If you often prioritize others’ needs over your own, there are sure signs to watch for:
o Difficulty in saying “no” or setting healthy boundaries
o Seek approval from others
o Inclined to be excessively concerned about others’ needs
o Experience a disconnect from one’s authentic self
o Likely to adapt your personality depending on the social environment you are in
o Feel guilty when your actions or decisions displease others
Why Am I Prone to Place Others’ Needs Above My Own?
Various factors have been psychologically examined that contribute to an individual’s tendency to people-please.
o Early Childhood Responsiveness
When children are exposed to unsafe and stress-induced environments, especially concerning expressing their needs and feelings, alongside self-expression being discouraged through overly critical parents, it results in insecure coping mechanisms. Children raised in unsupportive, strict environments, where they are expected to fit into the family mold and adhere to societal expectations, also contribute to developing insecure coping mechanisms (Davidson & McEwen, 2012; Malave et al., 2022; Georgescu & Bodislav, 2025). Their autonomy and will-power, self-esteem, and confidence are subdued in the process, forming insecure attachment styles, and they learn to avoid rejection at all costs (Li, 2022; Al’Dzaki, 2024). The act of anticipating others’ needs and prioritizing their well-being begins at a young age and can continue into adulthood without the individual realizing it (Georgescu & Bodislav, 2025).
o Trauma
Perceived traumatic experiences, especially during formative years, when the individual suffered neglect, humiliation, or abandonment, cultivate a subliminal connection between pleasing people and receiving care, experiencing safety or security, and feeling loved (Davidson & McEwen, 2012; Malave et al., 2022; Al’Dzaki, 2024).
o Fear of Rejection Coupled with Anxiety and Low Self-Esteem
Through continuous prioritization of other people’s needs and well-being above your own, you tend to develop the notion that your self-worth depends solely on the validation from external sources (Kuang et al., 2025). You also undergo a surge of fear to avoid disappointing others and learn to be constantly socially attentive, leading to the formation of an unhealthy coping mechanism (Ardana, 2025). In turn, people pleasing only ensures a short-term reward system feedback, but the underlying insecurity still looms and is indirectly strengthened.
o Cultural and Familial Expectations
In some instances, families and cultures have a high regard for prioritizing harmony and peacefulness, which can be associated with sacrificing an individual’s personal needs and promoting an image of overall well-being (Kuang et al., 2025). These family or cultural beliefs promote the habit of putting others first, even at the expense of your personal mental and physical health (Al’Dzaki, 2024; Georgescu & Bodislav, 2025).
People-Pleasing and Psychology
The action of prioritizing others’ needs above your own follows relational, developmental, and psychological patterns influenced by a variety of factors. Psychologically speaking, there are a few principal theories that navigate this behavioral characteristic.
1. Attachment Style Theory
Individuals with anxious attachment style (based on inconsistent caregiving or emotionally unavailable primary caregivers during childhood) are known to interact with other people through pleasing strategies to develop a sense of emotional security, decreasing their fear of being rejected or pushed away (Li, 2022). Key characteristic behaviors include being hypervigilant to others’ needs, suppressing their emotions, being excessively dedicated to caregiving of others, constantly needing approval and validation, as well as seeking intimacy, while surrendering their personal needs and well-being (Li, 2022; Charanya & Simon, 2024).
2. Trauma and Fawn Response
Trauma theory describes the people-pleasing tendency as a survival mechanism. It entails becoming subdued to neutralize potential threats, creating a space of security and safety (Maull, 2023). This is especially seen when the usual flight, fight, or freeze response to perceived threats, based on previous traumatic experiences, is not sufficient. In other words, the fawn response is used when conflict is to be avoided, and you put your own needs aside to assist someone else (Fawning: 11 Dangers of People-Pleasing Behavior, 2024). Individuals who habituate this coping mechanism undergo self-sacrifice and poor relational boundary setting in adulthood, alongside unresolved anxiety based on emotionally threatening situations in their past (Maull, 2023; Fawning: 11 Dangers of People-Pleasing Behavior, 2024).
3. Schema Theory or Subjugation Schema
Subjugation refers to relinquishing one’s control over one's own needs, or, in other words, allowing another individual to exert control over you. This is seen as a maladaptive pattern, especially in psychology. These individuals learn to become detached from their own needs to prevent an authority figure from being angry, avoid feeling shame, or being punished. Over a prolonged period, this dysregulated psychological pattern creates neural pathways where self-expression is tied to emotional pain and pleasing others, creating a false sense of security. These individuals also instinctively lack relational boundaries and continuously prioritize others' needs over their own to prevent negative consequences.
4. Self-Esteem Theory
When a person bases their value on how others value them, it creates an identity problem, where they compulsively seek approval from others and find it challenging to accept interpersonal tension and rejection (Georgescu & Bodislav, 2025). They tend to build their self-worth and identity on the approval and acceptance of others, with a focus on being likable (Li, 2022; Al’Dzaki, 2024; Kuang et al., 2025).
5. Social and Cultural Conditioning Theory
This is based on being accepted in society due to your cultural or familial belief system that you should prioritize harmony, peace, obedience, and self-sacrifice over your own needs, and being assertive should be avoided, as it creates conflict (Georgescu & Bodislav, 2025; Kuang et al., 2025). Being kind and helpful is embraced through emotional facilitation, which further drives this people-pleasing behavioral strategy based on the concept of conforming to what society deems acceptable (Al’Dzaki, 2024; Ardana, 2025).
How Does This Affect My Cognitive Function and Mental Well-Being in the Long Run?
Short-Term Cognition Impacted
· Overthinking and Hypervigilance Impair Executive Functions
If you tend to please people, you are likely to overanalyze social settings by anticipating others’ needs, which in turn affects your attention span, working memory, cognitive flexibility, and decision-making capabilities (Malave et al., 2022; Ardana, 2025). Your cognition is turned toward being attentive to others, which, in turn, induces stress; thus, self-reflection and careful planning are rendered futile (Brown et al., 2020).
· Limited Self-Reflection Ability
As soon as you become hyper-focused on other individuals, you disconnect from yourself (Al’Dzaki, 2024). You are likely to become detached from your own goals, likes, needs, and preferences, which can cause inner conflict in decision-making and limit your ability for introspection (Sari & Komarudin, 2024b; Ardana, 2025).
· Stress-Related Cognitive Fatigue
Through the above-mentioned short-term impact factors, you can also find yourself in a chronically induced anxious state (Georgescu & Bodislav, 2025). Experiencing people-pleasing tendencies can lead to a long-term elevation in stress hormones, such as cortisol and adrenaline (Palamarchuk & Vaillancourt, 2021b). When cortisol is consistently produced and released over a prolonged period, it disrupts executive function, attention, and memory (Davidson & McEwen, 2012; Brown et al., 2020). This causes challenges in concentration, problem-solving, and regulating emotions (Malave et al., 2022; Ardana, 2025).
Long-term Influence on Mental Well-being
· Anxiety and Depressive States
Individuals who people please will be constantly vigilant to ensure they avoid conflict, and that means to avoid disapproval, even if it costs them prioritizing their own needs (Sari & Komarudin, 2024b). Situations like these result in chronic stress, anxiety, and increase your risk for developing clinical depression (Martinez et al., 2020; Ardana, 2025; Georgescu & Bodislav, 2025).
· Burnout and Emotional Exhaustion
Forming the habit of putting others’ happiness above your own can cause emotional burnout and exhaustion (Ardana, 2025; Georgescu & Bodislav, 2025). Over time, it presents as numbness, loss of motivation, and feelings of fatigue.
· Loss of Identity and Low Self-Esteem
If you are consistently ensuring everyone’s needs are met, you tend to lose yourself. You will feel confused about your personal needs, values, your passions, and interests, creating an environment of low self-worth where you prioritize external validation for acceptance (Martinez et al., 2020; Li, 2022; Georgescu & Bodislav, 2025). This is due to the brain’s reward system, which comprises the prefrontal cortex, insula, and limbic regions, and is triggered by approval and appraisal (Palamarchuk & Vaillancourt, 2021b; Walsh et al., 2022; Wu & Hong, 2022). It plays a role in strengthening the reward activation pathway through the habit of people pleasing; however, over a prolonged period, this results in connecting self-worth to external validation.
· Physical Health Impact
Suffering from prolonged stress can trigger sleep disorders, headaches, and a dysregulated immune response, which can be associated with long-term complications such as autoimmune conditions, hypertension, cardiovascular disease, diabetes, and neurological deficits (Palamarchuk & Vaillancourt, 2021b).
Neural Pathway Involvement
Although certain aspects of people pleasing strengthen specific neural circuits in the brain through repetition, others are less active and can become weakened. In turn, this affects the brain's neural plasticity by altering how it organizes and responds to previous experiences. The following section examines the various pathways and specific brain regions involved in the response to constant people pleasing.
· The social network of the brain, involving empathy, understanding other individuals (theory of mind), as well as social reward pathways (mesocorticolimbic pathway), becomes stronger with continuous people pleasing occurring (Valk et al., 2017; Nguyen et al., 2021; Wu & Hong, 2022). These are the same pathways involved in expressing compassion and prosocial behavior (Valk et al., 2017; Wu & Hong, 2022). It ensures that these pathways are efficient, making the act of people pleasing instinctive. This is also partially due to the release of oxytocin, serotonin, and dopamine during social interactions, which provides a sense of belonging and bonding, highlighting feelings of prosocial and approval-seeking actions (Palamarchuk & Vaillancourt, 2021b; Dong et al., 2022; Malave et al., 2022; Walsh et al., 2022; Wang et al., 2025).
· Contrastingly, neural circuits involved in assertiveness, decision-making, and prioritizing yourself become weakened due to infrequent usage (Lanooij et al., 2022; Malave et al., 2022). Executive function and prefrontal control play significant roles in these pathways, but with underutilization, processes such as setting boundaries in social and professional settings become challenging.
· Furthermore, persistently anticipating others’ needs and well-being induces chronic stress. Continuously being in a high-stress environment causes elevated cortisol levels associated with a reduction in hippocampal function, decreased neurogenesis, a hypodopaminergic state, and the prevention of healthy neural plasticity (Davidson & McEwen, 2012; Brown et al., 2020; Dong et al., 2022; Malave et al., 2022; Walsh et al., 2022). Over the long run, this affects your overall cognitive health.
Different Brain Region Involvement
With chronic people pleasing, the amygdala reacts due to elevated sensitivity in this region of the brain (Davidson & McEwen, 2012). It causes people pleasers to feel threatened by enigmatic situations; settings where they are unsure of what to make of it. This results in a heightened fear and anxiety response, with a repeated activation of the fight-or-flight mechanism (Palamarchuk & Vaillancourt, 2021b). Along with elevated anxiety and fear, people-pleasers tend to go to extreme lengths to ensure other people’s needs are accommodated.
When it comes to self-regulation and sensible decision-making, the prefrontal cortex becomes dysregulated regarding these functions (Malave et al., 2022). In the face of emotional turmoil, distress, and circumstances that warrant conflict avoidance, the prefrontal cortex's activity is diminished (Davidson & McEwen, 2012). It causes individuals to find healthy boundary-setting challenging, alongside expressing their feelings, needs, and the impact of any situation on their well-being. In turn, people-pleasers automatically switch to conflict-avoiding strategies (Martinez et al., 2020).
With the sympathetic nervous system on constant high alert, inducing stress response activation, the body also experiences it. A “fawn” state of mind occurs frequently, which refers to a combination of freeze and submit responses, can impact the dorsal vagal (or parasympathetic) pathway, and in turn, leads to emotional exhaustion and hyperarousal (associated with coping strategies such as disconnect and numbness) (Palamarchuk & Vaillancourt, 2021b; Fawning: 11 Dangers of People-Pleasing Behavior, 2024).
In addition, the mesocorticolimbic pathway (known for its imperative role in the dopamine-based reward process) controls an individual’s satisfaction experienced from social interactivity of receiving external validation and feeling accepted (Walsh et al., 2022). This could lead to an unhealthy cycle of addictive tendencies for approval-seeking, due to the sense of satisfaction you receive from tending to people’s needs (Nguyen et al., 2021).
Therapeutic Approaches and Skill Training for Assertiveness and Boundary-Setting
Various therapeutic approaches are available that are suited to different individuals’ experiences of people pleasing. These techniques are integrated with nervous system regulation strategies, evidence-based therapy, and additional skills training to promote healthy assertiveness and practical boundary setting.
o Psychodynamic and Interpersonal Awareness highlights the exploration of the root of your people-pleasing tendencies. When you can identify the cause of this habit-forming behavior, you are more likely to gain a deeper understanding of yourself, allowing you to have honest feelings and responses to this behavior (Ardana, 2025).
o Acceptance and Commitment Therapy provides the tools to accept one’s emotions when experiencing discomfort or anxiety, and to set clear and healthy boundaries (Burton, n.d.). You can learn to identify what you value and what your principles are, without feeling the need to adapt them to others’ expectations and needs.
o Cognitive Behavioral Therapy (CBT) approaches assist in unlearning the habitual formation of people pleasing. Individuals can enhance this by learning the tools to be assertive and lay a foundation of self-compassion (Burton, n.d.; Osborn, 2024). The focus is on changing automatic negative perspectives of self-worth and how you experience rejection through self-affirming beliefs (Martinez et al., 2020). Following in-session training and role-playing techniques sets a foundation for realizing the value of your own needs, learning to build self-respect, and setting healthy boundaries (Osborn, 2024).
o With Dialectical Behavior Therapy (DBT), the focus is on interpersonal effectiveness and navigating social relationships with mindfulness (Burton, n.d.; Gilbert et al., 2020). It teaches you to vocalize and discuss your needs through clear and direct communication. Furthermore, it also aids in building tolerance against stress and anxiety, especially when you feel discomfort when in the position of setting boundaries (Sari & Komarudin, 2024b). Through these steps, you become aware of your emotional triggers when you are in the act of people-pleasing.
o Assertiveness Training techniques specifically focus on setting boundaries, enabling you to communicate your limits effectively (Li, 2022; Ardana, 2025). Along with scenario-training, a progress journal can help with self-reflection and SMART goal setting. In turn, neural networks become stronger through self-regulation and assertiveness.
o With self-compassion and self-care strategies, you actively work on how you view and value yourself. A balanced self-worth vision is essential for your well-being. Through these techniques, your self-worth improves, and you are less likely to be triggered by others’ reactions and less dependent on their approval (Burton, n.d.; Ardana, 2025). It also aids in rewiring the brain’s reward system, where you highlight internal contentment over external recognition and learn to prioritize your personal needs and wants.
o Social Skills Training is another aspect that goes hand-in-hand with the techniques mentioned above. Learning to communicate your needs and emotions effectively, and mitigating avoidance tactics through appropriate conflict resolution, is crucial for adapting from unintentional people-pleasing to nurturing healthy boundaries and relationships (Valk et al., 2017; Li, 2022; Ardana, 2025).
o Embracing bodily response awareness techniques, such as mindfulness, aids in regulating your nervous system (Davidson & McEwen, 2012). Using breathing techniques, muscle relaxation, and guided imagery can offer you support when in anxiety-inducing situations related to people-pleasing. Somatic experiences, EMDR, and polyvagal-informed techniques assist with trauma responses seen with the fawn response (Burton, n.d.; Fawning: 11 Dangers of People-Pleasing Behavior, 2024). You learn to build resilience and self-trust by applying these techniques. It also promotes improved self-awareness and builds on decision-making skills.
Practical Strategies for Prioritizing Your Emotional and Mental Well-Being
Adopting assertive strategies can be challenging at first; however, it is necessary to promote your overall well-being, both mentally and physically. The approaches below can be helpful in conjunction with other therapeutic techniques as discussed above (Li, 2022).
1. Communicate Clearly and Respectfully
Example: I appreciate the opportunity to work on this project; however, I will unfortunately be unable to take on any additional projects at this time.
You can have a respectful discussion where you maintain your boundaries, altogether avoiding apologizing for not meeting the other individual’s needs.
2. Your Body Language Reveals a Lot
Ensure you stand up straight, maintain eye contact with the person you are talking to, and calmly address the topic. It shows you are confident, remaining respectful, and highlights the importance of your words.
3. Implementing Boundaries Without Feeling Guilty
Example: I am not comfortable with the proposed idea, but let us find alternative options that work for both of us.
You ensure assertiveness by maintaining a confident stance on your opinion without being confrontational, while also showing that you are willing to solve the problem in an alternative way.
4. Your Priorities Matter
Example: Unfortunately, I have other things that require my attention right now, so I will have to pass this time.
You demonstrate that your needs are a priority by validating them yourself, without feeling guilty or overexplaining.
5. Think About it Before Saying Yes
You may ask for time to consider a decision, especially if you feel it may affect your well-being, whether emotionally or mentally. It also prevents automatic agreement and creates space for thoughtful consideration.
6. Practice Saying No
Saying no will become easier with practice. It can be done in a short, confident manner, which is still deemed respectful. When you prioritize your mental and physical well-being, you gain the power to set healthy boundaries.
7. Recognize Your Capacity and Express It
Example: I am currently at capacity. What should we prioritize?
This remains a respectful way to be assertive and set a boundary, while indicating that you are still open to collaboration but also expressing where your limit is.
Conclusion
When people-pleasing behavior becomes persistent, the long-term effect on cognitive function and emotional well-being is profound. Neural pathways become dysregulated, resulting in anxiety, burnout, as well as a loss of self-identification. Various factors contribute to the development of people-pleasing behavior, such as childhood experiences, attachment styles, trauma-related incidents, and social conditioning, leading to continuous cycles of neglecting oneself and seeking external validation, along with acceptance.
However, this behavioral characteristic can be changed when targeted therapeutic strategies are implemented, with specific approaches to cognition, somatic response, and relationship with yourself and others. It has the potential to build self-compassion and assertiveness while restructuring your cognitive function with healthy boundary setting and aiding in recreating your true self.
Although this area of psychosocial and neuroscience requires further exploration through longitudinal and transdiagnostic investigations, taking into account brain-imaging techniques, social, cultural, gender, and age-related factors, we can improve our understanding of our tendencies to place others’ needs over our own. Through this multidisciplinary approach, we can gain a deeper understanding from sociological, social psychological, and neurological perspectives, which can contribute to the development of improved therapeutic strategies.
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