Problems We Treat
Please click on a problem listed below to learn more.
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.
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.
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).
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.
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.
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:
- muscle tension
- head and neck pain
- gastrointestinal distress
- feeling keyed up and tense
- trouble concentrating
- trouble falling or staying asleep
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.
“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.”
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
- shortness of breath or smothering sensations
- feelings of choking
- chest pain or discomfort
- nausea or abdominal distress,
- feeling dizzy, unsteady, lightheaded, or faint
- 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.
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.
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.
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.
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.
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)
“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 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.
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
- relationship difficulties
- smoking cessation
- stress management
- life transitions