Obsessive-Compulsive Disorder (OCD)

DSM-5 Diagnostic Criteria for Obsessive-Compulsive Disorder

A. Presence of obsessions, compulsions, or both:

Obsessions are defined by:

  1. Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
  2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined by:

  1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
  2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

Note: Young children may not be able to articulate the aims of these behaviors or mental acts.

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).

Specify if:

With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.

With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true.

With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.

Specify if:

Tic-related: The individual has a current or past history of a tic disorder.

Intellectual/Developmental

Intellectual and Developmental Disabilities (ID/DD) Counseling

Oftentimes, it has been observed that individuals who have intellectual and/or developmental disabilities experience pain, not necessarily from their disability, but from depression, anxiety, or relationship issues in response to their disability.  While there are outstanding resources for the ID/DD population to assist them with challenges faced because of their disability, my goal is to address mental health issues often experienced apart from the disability. This is the purpose for incorporating Cognitive Behavior Therapy as part of the treatment plan .

Intellectual disability:

  •  A group of disorders characterized by a limited mental capacity and difficulty with adaptive behaviors such as managing money, schedules and routines, or social interactions.
  •  Originates before the age of 18 and may result from physical causes, such as autism or cerebral palsy, or from nonphysical causes, such as lack of stimulation and adult responsiveness.

 

Developmental disability:

  •  Severe, long term disability that can affect cognitive ability, physical functioning, or both.
  •  Appears before age 22 and are likely to be life-long.
  • The term “developmental disability” encompasses intellectual disability but also includes physical disabilities.
  • Some developmental disabilities may be solely physical, such as blindness from birth. Others involve both physical and intellectual disabilities stemming from genetic or other causes, such as Down syndrome and fetal alcohol syndrome for example.

Goal of Counseling:

  • To assist clients in developing a sense of self-empowerment in practical, emotional and social areas.
  • Coordination of care and networking with client’s various support systems  because most of us know it takes a team!

We as a society have come a long way thanks to the Americans With Disabilities Act (ADA) passed by Congress in 1990, however,  individuals with  “Different Abilities” often continue to face challenges and are misunderstood by society.

As a parent of a daughter born with Spina bifida who is now 30 years old.   I am thankful to have personally developed a sense of awareness in regards to individuals with disabilities  by witnessing struggles she has faced, as well as various other individuals we have interacted with throughout the years.

The “language” of therapists is also an important factor to consider when seeking counseling for individuals with ID/DD and their families.  For example,  we often continue to hear the term “wheelchair bound” even among some professionals.  Individuals who use wheelchairs would rather be referred to as just that.   Someone who “uses a wheelchair” is a much more acceptable term and defines a person as an independent individual rather than being “bound” to an object.  This is just one example of the importance of choosing a therapist who is multiculturally sensitive to the needs of individuals with “different abilities”.

Feel free to contact me today to schedule a session.

Teen Issues

In The Garden Counseling for Teen Issues

Teen / Children Issues

For a child, pre-teen, or teen with symptoms of a mental disorder, the earlier treatment is started, the more effective it can be. Early treatment can help prevent more severe, lasting problems as a child grows up.

Warning Signs

It can be tough to tell if troubling behavior in a child is just part of growing up or a problem that should be discussed with a health professional.  If there are signs and symptoms that last weeks or months; and if these issues cause impairment in daily functioning, not only at home but at school and with friends, you should contact a health professional.

Your child or teen might need help if he or she:

  • Often feels anxious or worried
  • Has very frequent tantrums or is intensely irritable much of the time
  • Has frequent stomachaches or headaches with no physical explanation
  • Is in constant motion, can’t sit quietly for any length of time
  • Has trouble sleeping, including frequent nightmares
  • Loses interest in things he or she used to enjoy
  • Avoids spending time with friends
  • Has trouble doing well in school, or grades decline
  • Fears gaining weight; exercises, diets obsessively
  • Has low or no energy
  • Has spells of intense, inexhaustible activity
  • Harms herself/himself, such as cutting or burning her/his skin
  • Engages in risky, destructive behavior
  • Harms self or others
  • Smokes, drinks, or uses drugs
  • Has thoughts of suicide
  • Thinks his or her mind is controlled or out of control, hears voices
    (Source: nimh.nih.gov)

According to the Population Reference Bureau (PRB)  Suicides have become the second-leading cause of death among teens in the United States, surpassing homicide deaths, which dropped to third on the list. The teenage suicide rate increased from 8 deaths per 100,000 in 1999 to 8.7 deaths per 100,000 in 2014. (prb.org)

It may be helpful for children and teens to save several emergency numbers to their cell phones. The ability to get immediate help for themselves or for a friend can make a difference.

  • The phone number for a trusted friend or relative
  • The non-emergency number for the local police department
  • The Crisis Text Line: 741741
  • The National Suicide Prevention Lifeline: 1-800-273-TALK (8255).

If you or your child is thinking about harming yourself get help immediately. You can call 911 or the National Suicide Prevention Line at 1.800.273.TALK (8255).

Grief and Loss

Grief Counseling Services with In The Garden Counseling

Coping with Grief & Loss: Understanding the Grieving Process and Learning to Heal

Coping with the loss of someone or something you love is one of life’s biggest challenges. Often, the pain of loss can feel overwhelming. You may experience all kinds of difficult and unexpected emotions, from shock or anger to disbelief, guilt, and profound sadness. The pain of grief can also disrupt your physical health, making it difficult to sleep, eat, or even think straight. These are normal reactions to significant loss. But while there is no right or wrong way to grieve, there are healthy ways to cope with the pain that, in time, can ease your sadness and help you come to terms with your loss, find new meaning, and move on with your life.

What is grief?

Grief is a natural response to loss. It’s the emotional suffering you feel when something or someone you love is taken away. The more significant the loss, the more intense your grief will be. You may associate grieving with the death of a loved one—which is often the cause of the most intense type of grief—but any loss can cause grief, including:

  • Divorce or relationship breakup
  • Loss of health
  • Losing a job
  • Loss of financial stability
  • A miscarriage
  • Retirement
  • Death of a pet
  • Loss of a cherished dream
  • A loved one’s serious illness
  • Loss of a friendship
  • Loss of safety after a trauma
  • Selling the family home

Even subtle losses in life can trigger a sense of grief. For example, you might grieve after moving away from home, graduating from college, or changing jobs. Whatever your loss, it’s personal to you, so don’t feel ashamed about how you feel, or believe that it’s somehow only appropriate to grieve for certain things. If the person, animal, relationship, or situation was significant to you, it’s normal to grieve the loss you’re experiencing.

How to cope with grief

While experiencing loss is an inevitable part of life, there are ways to help cope with the pain, come to terms with your grief, and eventually, find a way to pick up the pieces and move on with your life.

  • Acknowledge your pain.
  • Accept that grief can trigger many different and unexpected emotions.
  • Understand that your grieving process will be unique to you.
  • Seek out face-to-face support from people who care about you.
  • Support yourself emotionally by taking care of yourself physically.
  • Recognize the difference between grief and depression.

The grieving process

Grieving is a highly individual experience; there’s no right or wrong way to grieve. How you grieve depends on many factors, including your personality and coping style, your life experience, your faith, and how significant the loss was to you.

Inevitably, the grieving process takes time. Healing happens gradually; it can’t be forced or hurried—and there is no “normal” timetable for grieving. Some people start to feel better in weeks or months. For others, the grieving process is measured in years. Whatever your grief experience, it’s important to be patient with yourself and allow the process to naturally unfold.

Myths and facts about grief

  • Myth: The pain will go away faster if you ignore it.
  • Fact: Trying to ignore your pain or keep it from surfacing will only make it worse in the long run. For real healing, it is necessary to face your grief and actively deal with it.
  • Myth: It’s important to “be strong” in the face of loss.
  • Fact: Feeling sad, frightened, or lonely is a normal reaction to loss. Crying doesn’t mean you are weak. You don’t need to “protect” your family or friends by putting on a brave front. Showing your true feelings can help them and you.
  • Myth: If you don’t cry, it means you aren’t sorry about the loss.
  • Fact: Crying is a normal response to sadness, but it’s not the only one. Those who don’t cry may feel the pain just as deeply as others. They may simply have other ways of showing it.
  • Myth: Grief should last about a year.
  • Fact: There is no specific time frame for grieving. How long it takes differs from person to person.
  • Myth: Moving on with your life means forgetting about your loss.
  • Fact: Moving on means you’ve accepted your loss—but that’s not the same as forgetting. You can move on with your life and keep the memory of someone or something you lost as an important part of you. In fact, as we move through life, these memories can become more and more integral to defining the people we are.

The stages of grief

In 1969, psychiatrist Elisabeth Kübler-Ross introduced what became known as the “five stages of grief.” These stages of grief were based on her studies of the feelings of patients facing terminal illness, but many people have generalized them to other types of negative life changes and losses, such as the death of a loved one or a break-up.

The five stages of grief

Denial: “This can’t be happening to me.”

Anger: “Why is this happening? Who is to blame?”

Bargaining: “Make this not happen, and in return I will ____.”

Depression: “I’m too sad to do anything.”

Acceptance: “I’m at peace with what happened.”

If you are experiencing any of these emotions following a loss, it may help to know that your reaction is natural and that you’ll heal in time. However, not everyone who grieves goes through all of these stages—and that’s okay. Contrary to popular belief, you do not have to go through each stage in order to heal. In fact, some people resolve their grief without going through any of these stages. And if you do go through these stages of grief, you probably won’t experience them in a neat, sequential order, so don’t worry about what you “should” be feeling or which stage you’re supposed to be in.

Instead of a series of stages, we might also think of the grieving process as a roller coaster, full of ups and downs, highs and lows. Like many roller coasters, the ride tends to be rougher in the beginning, the lows may be deeper and longer. The difficult periods should become less intense and shorter as time goes by, but it takes time to work through a loss. Even years after a loss, especially at special events such as a family wedding or the birth of a child, we may still experience a strong sense of grief.” (Source: Hospice Foundation of America)

Symptoms of grief

While loss affects people in different ways, many of us experience the following symptoms when we’re grieving. Just remember that almost anything that you experience in the early stages of grief is normal—including feeling like you’re going crazy, feeling like you’re in a bad dream, or questioning your religious or spiritual beliefs.

Emotional symptoms of grief

Shock and disbelief – Right after a loss, it can be hard to accept what happened. You may feel numb, have trouble believing that the loss really happened, or even deny the truth. If someone you love has died, you may keep expecting them to show up, even though you know they’re gone.

Sadness – Profound sadness is probably the most universally experienced symptom of grief. You may have feelings of emptiness, despair, yearning, or deep loneliness. You may also cry a lot or feel emotionally unstable.

Guilt – You may regret or feel guilty about things you did or didn’t say or do. You may also feel guilty about certain feelings (e.g. feeling relieved when the person died after a long, difficult illness). After a death, you may even feel guilty for not doing something to prevent the death, even if there was nothing more you could have done.

Anger – Even if the loss was nobody’s fault, you may feel angry and resentful. If you lost a loved one, you may be angry with yourself, God, the doctors, or even the person who died for abandoning you. You may feel the need to blame someone for the injustice that was done to you.

Fear – A significant loss can trigger a host of worries and fears. You may feel anxious, helpless, or insecure. You may even have panic attacks. The death of a loved one can trigger fears about your own mortality, of facing life without that person, or the responsibilities you now face alone.

Physical symptoms of grief

We often think of grief as a strictly emotional process, but grief often involves physical problems, including:

  • Fatigue
  • Nausea
  • Lowered immunity
  • Weight loss or weight gain
  • Aches and pains
  • Insomnia

Seek support for grief and loss

The pain of grief can often cause you to want to withdraw from others and retreat into your shell. But having the face-to-face support of other people is vital to healing from loss. Even if you’re not comfortable talking about your feelings under normal circumstances, it’s important to express them when you’re grieving. While sharing your loss can make the burden of grief easier to carry, that doesn’t mean that every time you interact with friends and family, you need to talk about your loss. Comfort can also come from just being around others who care about you. The key is not to isolate yourself.

Finding support after a loss

Turn to friends and family members – Now is the time to lean on the people who care about you, even if you take pride in being strong and self-sufficient. Rather than avoiding them, draw friends and loved ones close, spend time together face to face, and accept the assistance that’s offered. Often, people want to help but don’t know how, so tell them what you need—whether it’s a shoulder to cry on, help with funeral arrangements, or just someone to hang out with. If you don’t feel you have anyone you can regularly connect with in person, it’s never too late to build new friendships.

Draw comfort from your faith –  Spiritual activities that are meaningful to you—such as praying, meditating, or going to church—can offer solace. If you’re questioning your faith in the wake of the loss, talk to a clergy member or others in your religious community.Join a support group – Grief can feel very lonely, even when you have loved ones around. Sharing your sorrow with others who have experienced similar losses can help.

Talk to a therapist or grief counselor –  An experienced therapist can help you work through intense emotions and overcome obstacles to your grieving.

 

Take care of yourself as you grieve

When you’re grieving, it’s more important than ever to take care of yourself. The stress of a major loss can quickly deplete your energy and emotional reserves. Looking after your physical and emotional needs will help you get through this difficult time.

Face your feelings. You can try to suppress your grief, but you can’t avoid it forever. In order to heal, you have to acknowledge the pain. Trying to avoid feelings of sadness and loss only prolongs the grieving process. Unresolved grief can also lead to complications such as depression, anxiety, substance abuse, and health problems.

Express your feelings in a tangible or creative way. Write about your loss in a journal. If you’ve lost a loved one, write a letter saying the things you never got to say; make a scrapbook or photo album celebrating the person’s life; or get involved in a cause or organization that was important to your loved one.

Try to maintain your hobbies and interests. There’s comfort in routine and getting back to the activities that bring you joy and connect you closer to others can help you come to terms with your loss and aid the grieving process.

Don’t let anyone tell you how to feel, and don’t tell yourself how to feel either. Your grief is your own, and no one else can tell you when it’s time to “move on” or “get over it.” Let yourself feel whatever you feel without embarrassment or judgment. It’s okay to be angry, to yell at the heavens, to cry or not to cry. It’s also okay to laugh, to find moments of joy, and to let go when you’re ready.

Plan ahead for grief “triggers.” Anniversaries, holidays, and milestones can reawaken memories and feelings. Be prepared for an emotional wallop, and know that it’s completely normal. If you’re sharing a holiday or life-cycle event with other relatives, talk to them ahead of time about their expectations and agree on strategies to honor the person you loved.

Create an Enjoyable Exercise Routine

Look after your physical health. The mind and body are connected. When you feel healthy physically, you’ll be better able to cope emotionally. Combat stress and fatigue by getting enough sleep, eating right, and exercising.

When grief doesn’t go away

As time passes following a significant loss, such as the death of a loved one, it’s normal for feelings of sadness, numbness, or anger to gradually ease. These and other difficult emotions become less intense as you begin to accept the loss and start to move forward with your life. However, if you aren’t feeling better over time, or your grief is getting worse, it may be a sign that your grief has developed into a more serious problem, such as complicated grief or major depression.

Complicated grief

The sadness of losing someone you love never goes away completely, but it shouldn’t remain center stage. If the pain of the loss is so constant and severe that it keeps you from resuming your life, you may be suffering from a condition known as complicated grief. Complicated grief is like being stuck in an intense state of mourning. You may have trouble accepting the death long after it has occurred or be so preoccupied with the person who died that it disrupts your daily routine and undermines your other relationships.

Symptoms of complicated grief include:

  • Intense longing and yearning for your deceased loved one
  • Intrusive thoughts or images of your loved one
  • Denial of the death or sense of disbelief
  • Imagining that your loved one is alive
  • Searching for your deceased loved one in familiar places Avoiding things that remind you of your loved one
  • Extreme anger or bitterness over your loss
  • Feeling that life is empty or meaningless

The difference between grief and depression

Remember, grief can be a roller coaster. It involves a wide variety of emotions and a mix of good and bad days. Even when you’re in the middle of the grieving process, you will still have moments of pleasure or happiness. With depression, on the other hand, the feelings of emptiness and despair are constant.

Contact a grief counselor or professional therapist if you:

  • Feel like life isn’t worth living
  • Wish you had died with your loved one
  • Blame yourself for the loss or for failing to prevent it
  • Feel numb and disconnected from others for more than a few weeks
  • Are having difficulty trusting others since your loss
  • Are unable to perform your normal daily activities

IF YOU ARE FEELING SUICIDAL :

Seek help immediately!  Talk to someone you trust, or call a suicide helpline:

Authors: Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D. Last updated: March 2018.
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Visit https://www.helpguide.org/ for the complete article which includes references, related articles and active links.

Additional Resources/Books:

When a Pet Dies

Getting to the Other Side of Grief

 

From we to Me

Depression

In The Garden Depression Counseling Services

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn’t worth living.

More than just a bout of the blues, depression isn’t a weakness and you can’t simply “snap out” of it. Depression may require long-term treatment. But don’t get discouraged. Most people with depression feel better with medication, psychotherapy or both.

Symptoms

Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

  • Feelings of sadness, tearfulness, emptiness or hopelessness
  • Angry outbursts, irritability or frustration, even over small matters
  • Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
  • Sleep disturbances, including insomnia or sleeping too much
  • Tiredness and lack of energy, so even small tasks take extra effort
  • Reduced appetite and weight loss or increased cravings for food and weight gain
  • Anxiety, agitation or restlessness
  • Slowed thinking, speaking or body movements
  • Feelings of worthlessness or guilt, fixating on past failures or self-blame
  • Trouble thinking, concentrating, making decisions and remembering things
  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
  • Unexplained physical problems, such as back pain or headachesFor many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

  • In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.
  • In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction. Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help.

Symptoms of depression may be different or less obvious in older adults, such as:

  • Memory difficulties or personality changes
  • Physical aches or pain
  • Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a medical condition or medication
  • Often wanting to stay at home, rather than going out to socialize or doing new
    things
  • Suicidal thinking or feelings, especially in older men
    When to get emergency help:If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.Also consider these options if you’re having suicidal thoughts:
  • Call your doctor or mental health professional.
  • Call a suicide hotline number — in the U.S., call the National SuicidePrevention Lifeline at 1-800-273-TALK (1-800-273-8255). Use that same number and press “1” to reach the Veterans Crisis Line.
  • Reach out to a close friend or loved one.
  • Contact a minister, spiritual leader or someone else in your faith community.
    (Source: mayoclinic.org)

    Take the first step in managing your depression by contacting us today!

Additional resources:

https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know/index.shtml#pub5

https://www.focusonthefamily.com/lifechallenges/emotional-health/depression/depression

 

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