Clinical focus
Obsessive-Compulsive Disorder
OCD is a neurological medical disorder, rather than a psychological anxiety disorder. It is characterized by intrusive, unwanted, repetitive obsessional thoughts and/or mental imagery and resulting compulsive behaviors and avoidance. These behaviors are time-consuming and interfere significantly with life. An obsession can occur with or without 'magical thinking.' Magical thinking connects an obsessive thought to a resulting action that is not logical or even physically possible.
There are many different possible themes, or fear structures, represented in OCD. It is common for an individual to have more than one:
Contamination
Feeling Just 'Right'
Need for Symmetry
Somatic (body-related)
Scrupulosity/Morality
Perfectionistic Concerns
Relationship/ROCD
Fear of Harm (active or passive, including catastrophic events)
Aggressive
Sexual
Sexual Orientation/HOCD
2.2 million adults, or 1% of US population; 1 in 100 adults and 1 in 200 children in the US; 1:1 female to male
Between the ages 8 and 12., Between the late teen years and early adulthood. Distress may fluctuate or be near-constant
Genetic heredity likely plays a significant role
Exposure and Response Prevention (ERP) and Pharmacotherapy
7 out of 10 respond well to treatment, obsessional content is unrelated to treatment outcome
Social Anxiety Disorder
Social Anxiety Disorder, or Social Phobia, is an intense fear of being judged, negatively evaluated, or rejected in a social or performance situation, such as conversing with a stranger, eating in front of others, or speaking in front of a group of people. It is diagnosed when the fear or anxiety is out of proportion to the actual threat posed by the social situation.
15 million adults in US, or 7%; 1:1 female to male
75% are diagnosed between ages 8 and 15 years
evidence for temperamental and genetic causal factors
Cognitive Behavioral Therapy (CBT), Exposure Therapy, and Pharmacotherapy
Post-Traumatic Stress Disorder
PTSD involves both exposure to actual or threatened death, serious injury, or sexual violence, and a resulting recurrent distress and avoidance for at least one month. Some individuals also experience dissociative symptoms, such as depersonalization or derealization. The most common trigger, rape, results in 65% of men and 46% of women developing PTSD.
7.7 million adults, or 8.7% of US population, an additional 5-15% experience a subclinical form of the disorder
can occur at any age after year one
evidence for environmental and temperamental causal factors
Prolonged Exposure (PE)
Body Dysmorphic Disorder
BDD is a complex condition involving environmental, sociocultural, and evolutionary risk factors. An individual with BDD may or may not have a physical defect that involves an excessive reaction such as intense scrutiny, compulsive and/or avoidant behavior related to the real or perceived defect. Perfectionistic beliefs may play a role in BDD thinking. In severe instances individuals may repeatedly present to dermatologic and cosmetic surgeons, or even perform self-surgeries. There is also a high likelihood of the presence of other concurrent mental disorders.
Up to 7.5 million adults or 2.4% of US adults, 1 in 50 adults; equal in males and females, although muscle dysmorphia, a specifier, is found almost exclusively in males
2/3 of individuals have onset before age 18, average age of onset is 12-13
both environmental and genetic causal factors
Cognitive Behavioral Therapy for Body Dysmorphic Disorder (CBT-BDD) and Pharmacotherapy
OCD Related Eating Issues
There sometimes is an interesting connection between OCD and eating issues. Several studies have assessed the prevalence of obsessive-compulsive disorder among those with an eating disorder, and prevalence rates have been described as high as 40%. More specifically, females with OCD had a 16-fold increased risk of having a co-morbid diagnosis of Anorexia Nervosa, and males with OCD had a 37-fold increased risk. I have worked in unison with excellent eating disorder specialists to treat individuals presenting with this combination of clinical symptoms.
evidence for heredity
Treatment involves simultaneous Exposure and Response Prevention (ERP) and comprehensive psychotherapy including hospitalization when necessary, Cognitive Behavioral Therapy (CBT), family therapy, and Pharmacotherapy
Health Anxiety (Hypochondriasis)
We can separate health anxiety into two groups of symptoms. The OC-related health anxiety is defined as a preoccupation with persistent fears of getting a serious disease, accompanied by related obsessional thoughts, compulsions, and avoidances. The somatic related Illness Anxiety Disorder involves a belief that one already has an undiagnosed, serious disease. There tend to be fewer obsessions and compulsions related to IAD.
similar in males and females, up to 10% of popluation
more commonly found in adults than children
evidence for environmental causal factors for Illness Anxiety Disorder; evidence of genetic causal factors for OCD
Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP)
Panic Disorder
Panic Disorder is diagnosed in individuals who experience panic attacks with no warning and have a preoccupying fear of additional, recurrent panic attacks for at least one month. Panic Disorder is often found with a number of comorbid conditions, most commonly agoraphobia: a fear of being in places in which escape might be difficult.
6 million adults, or 2.7% of US population; 2:1 female to male
onset is usually in adulthood, after age 20
evidence for genetic heredity
Highly responsive to Interoceptive Exposure Therapy
Specific Phobias
Specific phobias are characterized by marked fear or anxiety about a specific object or situation. Some examples of common phobias are: animals, heights, needles, and flying.
19 million adults in US, or 8.7% of population, 2:1 female to male
average age of onset is 7 years old
evidence for temperamental, environmental, and genetic causal factors
Highly responsive to Exposure Therapy
Generalized Anxiety Disorder
GAD is characterized by persistent and excessive worry about a number of things as opposed to more specific fear themes. Individuals may be preoccupied by a wide range of issues including money, health, job, or family. The key is that they find it very difficult, or even impossible, to control their worry.
6.8 million adults, or 3.1% of the US population, 2:1 female to male
The median age for onset is 30, but the age range is very wide
evidence for genetic, environmental, and temperamental causal factors
Pharmacotherapy and Cognitive Behavioral Therapy (CBT) have demonstrated effectiveness
Body Image Concerns
There are many people with body image issues who do not meet diagnostic criteria for Body Dysmorphic Disorder. Treatment may still be recommended if the individual's functioning is impaired due to these issues. If negative body image perception makes it more difficult to participate in day-to-day activities and pursue relationships, there are ways I can help.
occurs more frequently, but not exclusively, in women
Cognitive Behavioral Therapy (CBT) and insight-oriented psychotherapy have been helpful
Body Focused Repetitive Behavior
BFRBs refers to any repetitive self-grooming activity that results in damage to the body. These include trichotillomania (hair pulling), dermatillomania/excoriation (skin picking), onychophagia (nail biting), lip biting, and cheek chewing. Individuals who engage in BFRBs are oftentimes unaware of the behavior in the moment and are doing it to relieve tension or stress during sedentary activities.
up to 5% of general population, more often occurs in females
onset typically ages 11-15
both genetic and environmental are causal factors
Habit Reversal Training and Pharmacotherapy
Depression
There are many types of depressive disorders, each with its own data points. I will assess whether your depressive symptoms are primary, or secondary to another clinical issue. I will look for a pattern of depressed mood, loss of interest in activities, weight and sleep changes, feelings of worthlessness or excessive guilt, and suicidal thoughts.
300 million people worldwide experience depression, 1.5 to 3 times more common in females
may appear at any age with peak age adolescence
40% heretability
Behavioral Activation, Cognitive Behavioral Therapy (CBT), interpersonal psychotherapy, and Pharmacotherapy have all demonstrated effectiveness
"
You have honestly saved my life. I have not felt this calm in 7 years. Seeing you was the best decision I have ever made, you literally gave me my life back.
/ P.T., 36, male /