This chapter considers the everyday psychological and social costs attached to having pragmatic language difficulties. We briefly review key terminology concerning pragmatic language functions, before summarizing features of pragmatic language difficulties that occur in both the developmental period (e.g. associated with language impairment, autism spectrum disorder, hearing impairment, traumatic brain injury, intellectual disability) and in adulthood (e.g. in fronto-temporal dementia, aphasia, and Alzheimer's disease). We present a schematic model as a means of conceptualizing the elements of pragmatic language competence and its inverse, pragmatic language difficulties, within the broader psycho-social context. We argue that psychological factors such as coping style and self-efficacy for communication need to be considered alongside social factors (such as cultural mores and everyday communication contexts) if the true impact of pragmatic language difficulties is to be both documented and adequately addressed when interventions for affected individuals are designed, implemented, and evaluated.