Problems We Treat

Please click on a problem listed below to learn more.

“I don’t want to leave the house. Crowded places make me extremely uncomfortable. What if something bad happens and I can’t get out of there quickly enough?I would not be able to handle that!”

Agoraphobia is anxiety about being in places or situations where escape might be difficult or embarrassing or where help may not be available in the event of a panic attack or panic symptoms. Individuals who suffer from agoraphobia avoid such places or situations or tolerate them with extreme distress.

“I can’t seem to finish a project. Even if the majority of the work is done, I just can’t get myself to finish. And starting things, even little things like doing the laundry, is really hard for me. My husband and boss constantly get mad at me for not doing things that I’ve agreed to do. But honestly, it isn’t intentional. I just don’t remember. Half the time I can’t even remember where I put my car keys or cell phone!”

Attention Deficit Hyperactivity Disorder is an executive functioning problem originating in the prefrontal cortex of the brain. Executive functioning involves such processes as organizing; planning; sustaining attention for extended periods; paying attention to details; completing complex, multi-step tasks; controlling ones behavior during social interactions; and to some degree, regulating emotions. While research has shown that the prefrontal cortex is not fully developed until age 25, deficits in executive functioning usually appear prior to age 7.

There are three subtypes of ADHD:

  • Predominantly Inattentive, characterized by inattention, distractibility, failure to notice details, difficulty concentrating, and difficulty completing multi-step tasks.
  • Predominantly Hyperactive/Impulsive, characterized by  frequent fidgeting, difficulty sitting still or staying put, a tendency to blurt out comments or responses, excessive interrupting, and impulsiveness.

Combined subtype with symptoms of both inattentiveness and hyperactivity/impulsivity.

“I have episodes of feeling really hyper, full of energy, and acting impulsively and then I crash and get really depressed.”

Symptoms of bipolar disorder include both symptoms of depression and symptoms of mania or hypomania. Symptoms of mania include:

  • Emotions like euphoria, elation, and enthusiasm, and occasionally unpleasant emotions like anger and irritability
  • Behaviors like impulsively spending a lot of money, initiating multiple sexual liaisons, driving recklessly, making risky business investments, talking excessively, and staying up all night working or playing
  • Cognitions (thoughts) like, “I can do anything I want,” “I’m going to make a huge fortune,” “Everyone loves me,” and cognitive problems like racing thoughts and distractibility
  • Physical symptoms like reduced need for sleep, increased libido, and high energy levels.

The term hypomania is used to refer to mild symptoms of mania. Often individuals with bipolar disorder experience multiple episodes of depression and only one or an occasional manic or hypomanic episode. Sometimes individuals with bipolar disorder experience depressed and manic symptoms simultaneously (for example, feeling simultaneously depressed and revved up).

“Everything seems like a chore. I just don’t enjoy anything anymore.”

Symptoms of depression include:

  • Emotions like sadness, lack of enjoyment and satisfaction, guilt, irritability, loss of interest in others, feeling inadequate, and hopelessness
  • Behaviors like not doing things that were previously enjoyable, withdrawal from others, suicidal behaviors, and crying.
  • Cognitions (thoughts) like, “I’m worthless,” “No one cares about me,” and “The future is hopeless” as well as repetitive negative thoughts and memories, self-criticism, self-blame, and cognitive problems like difficulty concentrating or making decisions
  • Physical symptoms like fatigue, insomnia or oversleeping, loss of appetite or increased appetite

Symptoms of depression occur in several mood disorders, including Major Depressive Disorder, Dysthymia (a milder, but chronic mood disorder), and Bipolar Disorder.

In youth, depressive symptoms may also include irritability, acting out, and/or lashing out at others.

“My 7 year old son is still having accidents at school – help!”

Two major types of toileting problems exist: enuresis (the involuntary discharge of urine) and encopresis (the intentional or accidental discharge of feces). Toileting problems in youth can be due to organic causes (problems in the shape or innervation of the bladder), stressful life events, or anxiety and mood disorders, such as the child who fears being separated from his parents or fears being kidnapped so that he is unable to go to the toilet in the evening, even in his own home. Any or all of these problems can contribute to incomplete or failed toilet training.

“Even when things are okay, it’s almost like I look for something to worry about.”

Generalized anxiety disorder (GAD) is characterized by excessive anxiety and worry about a number of concerns such as health, money, family, and work. Individuals with GAD are plagued by worry. They tend to overestimate the severity of problems, viewing a headache as a sign of a possible brain tumor, for example, or an argument with their spouse as a sign that they could be headed for divorce. Individuals with generalized anxiety disorder find it difficult to control their worry thoughts and experience several distressing symptoms including:

  • fatigue
  • muscle tension
  • head and neck pain
  • gastrointestinal distress
  • irritability
  • feeling keyed up and tense
  • trouble concentrating
  • trouble falling or staying asleep
 “I haven’t had a good night sleep in weeks. I worry if I don’t get a good night’s sleep soon I won’t be able to function.”

Insomnia is defined as difficulty initially falling or staying asleep (early and middle insomnia, respectively), or waking too early (late insomnia).  Everyone experiences insomnia from time to time, but when it occurs frequently or chronically, it can have a considerable negative impact on quality of life, mood, energy, and productivity.  Sometimes sleep problems are part of a more global problem such as an anxiety or mood disorder. 

“My fears of contamination have become out of control. It seems like I’m always triggered by something that makes me want to wash and clean.”

“I’m often worried about being responsible for bad things happening. I worry that I didn’t turn off the stove or that I might have hit a pedestrian. I keep re-checking but never feel certain.”

“I feel so anxious because I keep having intrusive thoughts of harming people I love. No matter how hard I try, I can’t make the thoughts stop. “

Obsessive-compulsive disorder (OCD) is characterized by obsessions and compulsions. Obsessions are recurrent and persistent intrusive thoughts, urges, or images that feel unacceptable and unwanted. They cause significant distress or make it difficult to carry out daily activities. Even when an individual tries hard to suppress an obsession, it continues to intrude. Obsessions often involve excessive doubt and difficult tolerating uncertainty. Common obsessions involve fears of contamination by dirt or germs, concerns about being responsible for harm coming to others, excessive needs for order, symmetry, or completion, and unacceptable violent, sexual, or blasphemous thoughts and images.

Compulsions are rigid and repeated behaviors or mental acts that are performed in order to prevent a feared outcome (such as contracting AIDS or harm coming to family members) or to reduce the distress caused by an obsession. Individuals often feel driven to perform compulsions even though they don’t want to and try to resist them. Common compulsions include excessive washing, repeated checking and reassurance-seeking behaviors, and counting or repeating certain numbers, words, or phrases.

In youth, repetitive attempts at gaining reassurance from adults and/or confessing to adults about thoughts or urges may be the most prominent compulsion. Obsessions may take the form of rigidly having to do something a certain way or redoing something until it is “just right.”

“When I have a panic attack, I feel like I’m dying. Now I’m scared to drive on the freeway. What if I have a panic attack when I’m driving?”

A panic attack is a discrete period of intense fear or discomfort, during which one or several physical symptoms develop abruptly.

These symptoms can include:

  • heart palpitations
  • pounding heart
  • accelerated heart rate
  • sweating
  • trembling
  • shortness of breath or smothering sensations
  • feelings of choking
  • chest pain or discomfort
  • nausea or abdominal distress,
  • feeling dizzy, unsteady, lightheaded, or faint
  • unreality
  • feeling detached from one’s self
  • numbness or tingling
  • chills or hot flushed
  • fear of losing control or going crazy
  • fear of dying or having a heart attack

Panic disorder is characterized by recurrent, unexpected panic attacks along with persistent concern about having another attack, worry about the consequences of an attack, or behavioral changes because of the attack.

“I can’t seem to keep it up like I used to. The drugs my doctor prescribed don’t seem to help much. My partner and I have not even tried in months because I am afraid I will fail, and she no longer approaches me because she is afraid to upset me.”

Sexual dysfunction is a persistent, recurrent problem with one or more of the normal phases of sexual response, including:

  • Diminished sexual desire or drive
  • Aversion to sexual activity
  • Difficulty attaining or maintaining arousal (including erection or lubrication)
  • Delayed or absent orgasm
  • Premature ejaculation
  • Pain during sexual activity
  • These problems either cause the individual experiencing them distress, and/or generate relationship distress.
“I don’t know what to do. My teenage son refuses to go to school, and I cannot just pick him up and put him in the car. He’s getting so far behind, but won’t even try to go for part of a day!”

There are a number of reasons why a child or adolescent will refuse to attend school, including being bullied or teased by peers; feeling demoralized and depressed about academics due to a learning disability; or experiencing anxiety or fear about something in school, such as fearing that they might throw up or have a panic attack, or when separating from primary caretakers. Regardless the reason for the refusal, not attending school has serious academic and social consequences for children and adolescents.

“I don’t understand… my child is so talkative. At home she is often the center of attention, but when she gets to school she completely clams up and won’t speak a word to her teacher.”

Selective Mutism occurs when an individual refuses to speak in many or all situations; typically refusal to speak occurs outside of the home or when away from family members. Selective Mutism differs from shyness which may result in an individual taking longer than typical to warm up others but once the individual has warmed up, he or she is able to interact freely both verbally and nonverbally. The impact of Selective Mutism upon the silent individual is enormous, as he or she misses opportunities to make friends, achieve academic milestones, and participate in academic or after school activities, all of which depend on his or her willingness to speak and interact with others.

“My child follows me around the house sometimes and always wants me to stay at his sports practices and birthday parties, even though none of the other parents stay.”

While for most individuals, separation from parents after preschool is not a problem; for 3-5% of youth, separation remains a terrifying ordeal. When separated from their primary caretakers, these individuals fear that they or a parent will be harmed or that they will be abandoned. Individuals with separation anxiety may refuse to attend school, go to parties, sleepovers, or participate in other developmentally appropriate activities. Physical complaints are also sometimes common in these individuals prior to or when separation from major attachment figures occurs.

“I’m terrified of spiders. I don’t go hiking or take my daughter to the park any more. It makes me too anxious.”

Specific phobia is an excessive or unreasonable fear triggered by the presence or anticipation of an object or situation. An individual with a specific phobia experiences anxiety, which may take the form of a panic attack, when he or she is exposed to the feared object or situation. The individual is aware that the fear is irrational or excessive; avoids the feared object or situation or endures it with intense anxiety or distress; and experiences anxiety, anxious anticipation, or avoidance that significantly interferes with his or her life or causes great distress.

Types of specific phobias include:

  • animal phobias (animals, birds, insects, spiders)
  • natural environment phobias (heights, the dark, water, storms)
  • situational phobias (airplanes, elevators, tunnels, trains)
  • blood, injection, and injury phobias (sight of blood, receiving injections, or any bodily damage)
  • other phobias (foods, sounds, vomiting)
“If I have to speak in front of people, I get so anxious I can’t stand it. I won’t sign up for a class if I have to give an oral presentation. It’s just not worth it.”

“I’m afraid to start conversations with people I don’t know. What if I say something stupid? I get so embarrassed.”

Social anxiety disorder involves an intense and persistent fear of one or more social or performance situations. Individuals with social anxiety disorder:

  • fear that they will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing and that others will scrutinize or judge them
  • experience anxiety, which may take the form of a panic attack, whenever they are in feared social situations
  • often avoid feared social situations or endure them with intense distress
  • find that their avoidance, anxious anticipation , or distress in feared social situations significantly interferes with their lives

They types of social situations that individuals fear or avoid include: public speaking, initiating or maintaining conversations, speaking to individuals in authority, dating, parties, eating or drinking in public, writing in public, and using public restrooms.

“I feel for hairs that are coarser and thicker than the others, and I pull out each one, rolling the root between my thumb and finger. It feels relaxing to do this—until I notice all the hairs I’ve pulled. Then I feel deeply ashamed.”

“I can’t stand the bumps on my skin. When I find a bump or scab, I need to pick it and make my skin smooth. I feel I have to get rid of the imperfections. Once I start, I zone out and keep picking. At first it feels like a relief, but then I feel guilty and ashamed. Sometimes my skin becomes infected.”

Trichotillomania (hair pulling), skin picking, biting the insides of the cheeks, and nail biting are considered body-focused repetitive disorders (BFRBs). Trichotillomania is repetitive pulling out of one’s hair. Hair may be pulled from any location of the body, including the scalp, eyelashes, eyebrows, and pubic area. Pulling often feels pleasurable and provides a sense of relief. After pulling, an individual may play with or eat the hair. Pulling may be focused and planned or may occur in a less focused manner when individuals are “zoned out.” Over time, the pulling can result in notable hair loss that can significantly interfere with an individual’s functioning and happiness.

Pathological skin picking is a repetitive behavior that involves recurrent picking, scratching, or biting the skin. Individuals commonly pick at scabs, acne or other skin imperfections. These behaviors become clinical concerns when an individual is unable to stop the behavior despite significant skin damage, or when the behavior leads to significant distress.

“Sometimes I’m jerking my head so much that my neck and shoulders are on fire with pain, but I can take that. It’s the way the kids laugh at me that really bothers me. Sometimes I don’t want to go to school. I hate my tics.”

Tics are sudden, involuntary and nonrhythmic behaviors that begin in childhood and tend to come and go. People can suppress tics temporarily. Tics are preceded by a premonitory urge, which is a feeling or sensation that signals the tic is coming. Tics can be vocal (phonic) or physical (motor) or a combination, as in the case of Tourette’s disorder. Vocal and motor tics can be simple (throat clearing or eye blinking) or complex (repeating a word or phrase or bending or gyrating the body). People with tics, particularly children, may suffer socially because others view the tics as weird or bizarre. Further, severe tics can interfere with the individual’s academic or social functioning.

Other problems we treat include:

  • decision-making difficulties
  • low self-esteem
  • noncompliance with medical recommendations
  • overeating
  • perfectionism
  • procrastination
  • relationship difficulties
  • smoking cessation
  • stress management
  • life transitions
  • unassertiveness

Please contact us if you have any questions as to whether we provide treatment for other problems not specifically listed here.