When Strength Becomes Exhaustion: Women, Epilepsy, and the Pressure to Be Everything

Because resilience should not require sacrificing your wellbeing.

The Cost of Being “Superwoman”

Women’s History Month, Epilepsy, and the Invisible Weight So Many Women Carry

March invites us into several important conversations at once. It is Women’s History Month. It is also a time when the epilepsy community pauses to honor International Women with Epilepsy Day on March 1 and Purple Day for epilepsy awareness on March 26. These observances matter because they remind us that women’s lives, women’s health, and women’s stories deserve to be seen in their full complexity.

As a therapist, I work with women who carry a great deal. Some are living with epilepsy and navigating the emotional, relational, and practical realities of a neurological condition that other people often do not fully understand. Others are high-achieving women who do not have epilepsy, but who still live under intense pressure to keep producing, keep performing, keep caregiving, and keep holding everything together. Many of the women I serve are BIPOC women whose strength has been shaped not only by personal ambition, but by survival, systemic stress, and the expectation that they must endure without falling apart.

Different stories. Different diagnoses. Different lives.

And yet the emotional pattern is often strikingly similar.

Many women have learned that love is earned through usefulness. That rest must be justified. That asking for help is risky. That softness is a luxury. That if they want to be respected, they have to be exceptional. That if they want to survive, they have to be strong all the time.

When Strength Becomes a Survival Strategy

This is where the conversation about Superwoman Syndrome becomes so important.

Superwoman Syndrome is not a formal diagnosis, but it is a very real lived experience. It describes the chronic pressure many women feel to be endlessly capable, emotionally composed, high functioning, nurturing, and resilient, even when they are exhausted. It is the internalized belief that you should be able to carry the job, the household, the caregiving, the relationships, the emotional labor, the planning, the crisis management, and your own pain without dropping anything.

For some women, that pressure leads to burnout. For others, it leads to anxiety, depression, irritability, perfectionism, shame, emotional numbness, or difficulty connecting with their own needs. For women with chronic illness, including epilepsy, that pressure can become even more harmful because it asks the body to keep pushing long after it has asked for care.

Women and Epilepsy: More Than Seizures Alone

Epilepsy affects an estimated 65 million people worldwide, about 3.4 million people in the United States, about 1.1 million women in the United States, and roughly 25 million women worldwide. Those numbers matter because they remind us that women with epilepsy are not a small or invisible population. They are students, mothers, professionals, caregivers, partners, leaders, creatives, advocates, and high achievers. They are often trying to manage both a medical condition and the social expectation that they should not let that condition slow them down.

For women with epilepsy, the burden is rarely limited to seizures alone. Epilepsy can affect confidence, work life, dating and relationships, family planning, and mental health. Women may have to think about how hormones affect seizure activity, whether medications interact with birth control, what pregnancy planning may require, how sleep deprivation affects seizure threshold, and how much of their diagnosis they feel safe disclosing in professional or personal settings. Women with epilepsy often have to make decisions that other people never even have to think about. Research and clinical guidance continue to recognize that women with epilepsy face distinct issues related to menstruation, contraception, pregnancy, and hormonal transitions across the lifespan.

Catamenial Epilepsy: When Hormones Affect Seizures

One aspect of epilepsy that is unique to women is catamenial epilepsy, which refers to seizure patterns that are influenced by hormonal fluctuations during the menstrual cycle.

Hormones like estrogen and progesterone affect the brain’s electrical activity. Estrogen tends to increase excitability in the brain, while progesterone tends to have more stabilizing effects. Because these hormones rise and fall during the menstrual cycle, some women notice that their seizures become more frequent or more intense at certain points in the month.

This can be especially frustrating and confusing for women who are already trying to manage an unpredictable condition. A woman may feel like she is doing everything “right” and still notice changes in seizure activity because of hormonal shifts that are outside of her control. For some, seizures may increase before menstruation. For others, they may intensify around ovulation or during other hormonal transitions such as puberty, pregnancy, postpartum, or menopause.

Catamenial epilepsy adds another layer to the emotional and physical load many women already carry. It may require tracking cycles alongside seizure activity, noticing patterns over time, and advocating for care that takes both neurological and hormonal health seriously. It can also intensify feelings of frustration, exhaustion, anxiety, and disconnection from one’s own body.

For many women, simply having language for this experience can be validating. It can help them understand that their bodies are not failing them. Their bodies are communicating something important.

The Stigma of Living in a Misunderstood Body

For women with epilepsy, another layer is often present: the emotional experience of living in a body that other people misunderstand. Epilepsy is still heavily stigmatized. Some women fear being seen as unreliable, incapable, dramatic, or unsafe. Some have had their symptoms minimized. Some have had to educate employers, partners, or even family members. Some have internalized shame about needing accommodations, medication, or extra recovery time. Anxiety and depression are also common in epilepsy, and many women carry the emotional burden of trying to appear okay even when they are struggling.

There can be a particular loneliness in living with a condition that others do not fully understand. When the body feels unpredictable and the world responds with judgment, misinformation, or fear, many women learn to hide parts of their experience. They may downplay symptoms, overcompensate, or hesitate to ask for support. Over time, that can create a painful split between what they are actually living and what they feel allowed to reveal.

Living With Unpredictability

There is also the emotional toll of unpredictability. When your body can feel unreliable, even temporarily, it can shape the way you move through the world. Some women become hypervigilant. Some become overly self-disciplined in an attempt to create control. Some overwork so no one can question their competence. Some under-share because they are tired of stigma. Some silence their fear because they do not want to be treated as fragile. These are not character flaws. These are adaptations. They are often intelligent responses to a world that does not always make room for vulnerability.

The High-Achieving Women Who Are Quietly Running on Empty

The women I work with who do not have epilepsy often know this emotional terrain too, even if the pathway looks different. They may be executives, therapists, business owners, caregivers, graduate students, nonprofit leaders, or women holding families and communities together behind the scenes. They are often praised for being dependable, strong, organized, insightful, and able to handle a lot. But beneath that praise, there can be profound fatigue. They may feel trapped by the very identity that others admire in them. If everyone sees you as the strong one, where do you go when you are the one who needs support?

That is part of why high-achieving women are so vulnerable to Superwoman Syndrome. Achievement can become both a gift and a defense. It can bring purpose, fulfillment, and agency. It can also become a way of proving worth, avoiding disappointment, managing anxiety, or staying ahead of rejection. Many women have learned, explicitly or implicitly, that mistakes are dangerous, rest is laziness, and slowing down means falling behind. When that mindset becomes chronic, the nervous system may remain in a near-constant state of activation. The body pays for that over time.

The Unique Burden Many BIPOC Women Carry

For BIPOC women, this experience is often intensified by cultural and systemic realities. The pressure is not only to succeed, but to survive environments that may already be questioning their competence, diminishing their humanity, or asking them to carry more with less support. Other literature has also linked this pattern to self-silencing and reduced help-seeking.

That matters deeply in this moment.

When high-achieving BIPOC women move through workplaces, institutions, and even relationships where they experience microaggressions, chronic invalidation, or the pressure to outperform in order to receive basic recognition, the emotional load compounds. Racialized and gendered stressors are not separate from mental health. They shape mental health. Chronic exposure to microaggressions can contribute to cumulative emotional and physiological burden over time.

This is why culturally responsive therapy matters. Healing cannot only focus on the individual as if she exists outside of context. A woman’s distress may not be coming from poor coping alone. It may be coming from the collision between her internal world and the demands of the systems around her. It may be rooted in the fact that she has had to be resilient for too long. It may be rooted in grief, invisibility, role strain, illness, racial stress, perfectionism, trauma, or all of them at once.

The Strong Black Woman Schema: When Strength Stops Feeling Like a Choice

One framework that helps us understand this experience more deeply is the Strong Black Woman Schema. This refers to the expectation, both internal and external, that Black women must always be strong, self-sufficient, emotionally contained, nurturing, and able to endure hardship without breaking.

For many Black women, this identity did not emerge out of nowhere. It has roots in survival, history, family systems, culture, and lived experience. Strength has often been necessary. Endurance has often been adaptive. The problem is not strength itself. The problem is when strength stops feeling like a resource and starts feeling like a requirement.

The Strong Black Woman Schema can show up in many ways. It can look like being the one everyone depends on while feeling like you have no room to fall apart. It can look like minimizing your own pain because other people “have it worse.” It can look like struggling to ask for help, feeling guilty for resting, staying emotionally guarded, or believing that vulnerability is unsafe. It can also show up in overachievement, people-pleasing, emotional suppression, hyper-independence, and chronic overfunctioning.

On the outside, this may be praised. A woman may be called resilient, dependable, driven, or unshakeable. On the inside, she may feel lonely, exhausted, unseen, and disconnected from her own needs.

This is where therapy can become deeply reparative.

Compassion-Focused Therapy can help challenge the shame that often forms around having needs at all. It supports women in developing a gentler inner voice and recognizing that self-compassion is not weakness. It is a necessary part of healing.

Narrative Therapy can also be especially powerful. It allows women to examine the stories they have inherited about strength, survival, and womanhood. It creates space to ask important questions: Who taught me that I always have to be the strong one? What has that story cost me? What parts of me have been buried underneath it? What would it look like to author a fuller, more humane story about who I am?

Other culturally affirming modalities may include relational therapy, somatic work, strengths-based approaches, liberation-informed therapy, and interventions that honor spirituality, ancestry, and collective experience. Healing is not about stripping away strength. It is about expanding a woman’s sense of self so that strength is no longer the only part of her that gets to exist.

The goal is not to make Black women less strong.

The goal is to make space for softness, complexity, interdependence, grief, joy, and rest to belong too.

So What Does Healing Look Like?

Healing often begins with helping women tell the truth.

The truth that they are tired.
The truth that they are grieving.
The truth that they have spent years overfunctioning.
The truth that being needed is not the same thing as being nurtured.
The truth that performing strength is not the same thing as feeling safe.
The truth that resilience is beautiful, but it should not be the only option.

In my work, psychoeducation is a big part of that process. Many women feel relief when they realize their burnout is not a personal failure. Their anxiety is not “too much.” Their need for rest is not laziness. Their emotional shutdown is not evidence that they do not care. Often, their mind and body have simply been trying to survive under sustained pressure.

Therapy That Helps Women Come Home to Themselves

Several therapy modalities can be especially supportive here.

Compassion-Focused Therapy can be powerful for women who are outwardly nurturing but internally harsh with themselves. Many high-achieving women know how to extend grace to everyone except themselves. They may understand empathy intellectually but still speak to themselves in ways they would never speak to someone they love. Compassion-focused work helps clients notice shame-based inner dialogue, understand the protective function of self-criticism, and begin building a kinder internal relationship. For women with epilepsy, this may include reducing shame around limitations, medication, memory issues, fatigue, or the unpredictability of seizures. For high-achieving women more broadly, it may mean learning that their worth is not contingent on constant productivity.

Acceptance and Commitment Therapy can also be deeply meaningful. ACT does not ask people to like pain or pretend stress is not real. It helps them stop organizing their entire life around avoiding discomfort. Many women are trapped in cycles of overperformance because slowing down brings guilt, fear, sadness, or vulnerability to the surface. ACT helps clients make room for those emotions while still moving toward their values. It can be especially useful for women learning to choose a life that is aligned rather than merely impressive.

Somatic and nervous system-based approaches matter too, especially for women whose bodies have been carrying stress for a long time. When someone has lived in survival mode, insight alone is often not enough. She may understand perfectly well that she deserves rest, but still feel agitated when she tries to take it. She may know she is safe, but her body may still be bracing. Therapy can help reconnect the body and mind through grounding, breathwork, pacing, self-observation, and learning how to identify cues of activation before overwhelm takes over.

Solution-Focused and strengths-based work is also important, particularly for women who are used to seeing themselves through a deficit lens. Therapy is not only about naming pain. It is also about recognizing adaptive brilliance. Many women who feel depleted have also survived incredible things. They have insight, endurance, discernment, creativity, and leadership. The goal is not to romanticize suffering, but to help women reconnect with the strengths that can support healing rather than only survival.

A Practice to Try: Pause, Name, Need

One exercise I often find especially meaningful is what I call the Pause, Name, Need practice. It is simple, but it can be surprisingly powerful for women who are used to overriding themselves.

When you feel overwhelmed, stop for one moment and ask:

What am I feeling right now?
What is this feeling trying to tell me?
What do I need in this moment?

The first question builds emotional awareness.
The second question builds curiosity instead of judgment.
The third question builds self-trust.

For example, a woman might realize, “I’m not just irritated. I’m depleted.” Or, “I’m not failing. I’m overloaded.” Or, “What I need is not more discipline. What I need is rest, support, and space.” This practice can interrupt autopilot and create a small but meaningful shift from self-abandonment to self-attunement.

Daily Skills That Support Sustainable Wellbeing

Other daily skills can help as well. Energy budgeting can be transformative for women who are used to operating as if their capacity is unlimited. This means intentionally acknowledging that time and energy are not the same thing. You may have ten hours available in a day and still not have the emotional or physical bandwidth for ten hours of output. For women with epilepsy, this can be especially important because sleep, stress, overstimulation, and hormonal shifts may all affect functioning. For high-achieving women in general, it can be a way of learning that being effective does not require being perpetually depleted.

Boundaries are another critical part of healing, though they are often harder in practice than they sound in theory. For many women, particularly women socialized to be accommodating, boundaries trigger guilt. For BIPOC women, boundaries may also collide with cultural expectations, role obligations, or fears about being labeled difficult, selfish, angry, or ungrateful. Therapy helps women understand that boundaries are not punishments. They are a way of creating conditions where care, honesty, and sustainability can exist.

Rest also deserves to be reclaimed, not as a reward for overwork, but as a human need. Many women have only been taught two modes: pushing through or shutting down. Sustainable wellbeing requires a third option, which is intentional regulation before collapse. This might look like a slower morning, less multitasking, asking for help sooner, leaving margin between commitments, being honest about capacity, or choosing not to prove yourself in spaces committed to misunderstanding you.

The Question Beneath It All

At the emotional core of all of this is one question: who are you allowed to be when you are not performing strength?

For some women, that question unlocks grief. For others, anger. For others, relief. Because underneath Superwoman Syndrome, there is often a part of someone who is longing to exhale. A part who does not want to earn rest anymore. A part who wants to be cared for without first having to break. A part who wants to be seen as fully human, not just endlessly capable.

That is often the work.

Not teaching women how to become stronger than they already are.

Teaching them how to live without constantly abandoning themselves.

A Different Kind of Strength

As we move through Women’s History Month, International Women with Epilepsy Day, and Purple Day, I think it is important to celebrate women not only for what they achieve, but for what they carry. I think it is important to honor women with epilepsy whose strength is often invisible. I think it is important to honor high-achieving women who look composed on the outside and feel exhausted on the inside. I think it is important to honor BIPOC women whose resilience has too often been demanded instead of supported.

You do not have to earn softness.
You do not have to justify your exhaustion.
You do not have to wait until your body forces you to stop before your needs become valid.

Whether you are managing epilepsy, burnout, anxiety, perfectionism, racialized stress, trauma, or the chronic pressure to be everything for everyone, you deserve a space where you do not have to perform. You deserve a space where your whole self can be held with care.

That is the kind of healing many women have been waiting for.

You Deserve Support Too

If this resonates with you, therapy can be a space where you no longer have to carry everything alone.

At Metamorphosis Counseling and Wellness Collective, I work with women across North Carolina who are navigating epilepsy, burnout, anxiety, perfectionism, trauma, life transitions, and the pressure to always be the strong one. My approach is compassionate, culturally responsive, and grounded in helping women reconnect with themselves in ways that feel sustainable and healing.

You deserve support that sees the full picture.
You deserve care that honors both your strength and your humanity.
You deserve a place where you do not have to perform in order to be held.

To learn more about working with me or to schedule an appointment, please visit Metamorphosis Counseling and Wellness Collective through the contact page or website.