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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.

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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.

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Workplace Stress

Workplace Stress Counseling Services

Some workplace stress is normal. However, excessive stress can interfere with your productivity and performance, impacting your physical and emotional health. Workplace stress can also affect your relationships and home life, and even mean the difference between success and failure on the job. While you can’t control everything in your work environment, that doesn’t mean you’re powerless—even when you’re stuck in a difficult situation.

Whatever your ambitions or work demands, there are steps you can take to protect yourself from the damaging effects of stress, improve your job satisfaction, and bolster your well-being in and out of the workplace.

 

Additional Resource:

http://www.apa.org/helpcenter/workplace-stress.aspx

 

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Trauma and Recovery

Trauma Counseling in Statesville NC

If you’ve experienced an extremely stressful or disturbing event that’s left you feeling helpless and emotionally out of control, you may have been traumatized. Psychological trauma can leave you struggling with upsetting emotions, memories, and anxiety that won’t go away. It can also leave you feeling numb, disconnected, and unable to trust other people. When bad things happen, it can take a while to get over the pain and feel safe again. 

Emotional and psychological trauma is the result of extraordinarily stressful events that shatter your sense of security, making you feel helpless in a dangerous world. Traumatic experiences often involve a threat to life or safety, but any situation that leaves you feeling overwhelmed and isolated can be traumatic, even if it doesn’t involve physical harm. It’s not the objective facts that determine whether an event is traumatic, but your subjective emotional experience of the event. The more frightened and helpless you feel, the more likely you are to be traumatized. 

Emotional and psychological trauma can be caused by: 

One-time events, such as an accident, injury, natural disaster, or violent attack

Ongoing, relentless stress, such as living in a crime-ridden neighborhood or battling a life-threatening illness 

Commonly overlooked causes, such as surgery (especially in the first 3 years of life), the sudden death of someone close, the breakup of a significant relationship, or a humiliating or deeply disappointing experience 

  • It happened unexpectedly.
  • You were unprepared for it.
  • You felt powerless to prevent it.
  • It happened repeatedly.
  • Someone was intentionally cruel.
  • It happened in childhood

 

Additional Resources:

https://www.aacc.net/2018/02/02/the-common-thread-found-in-primary-and-secondary-abuse-and-its-consequences/

https://www.goodtherapy.org/learn-about-therapy/issues/ptsd

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Stress Management

In The Garden Stress Management Counseling

Stress Symptoms: Effects on Your Body and Behavior

Symptoms of stress may be affecting your health, even though you might not realize it. You may think illness is to blame for that nagging headache, your frequent insomnia or your decreased productivity at work. But stress may actually be the culprit.

Common Effects of Stress

Indeed, stress symptoms can affect your body, your thoughts and feelings, and your behavior. Being able to recognize common stress symptoms can give you a jump on managing them. Stress that’s left unchecked can contribute to many health problems, such as high blood pressure, heart disease, obesity and diabetes.

Common Effects of Stress on Your Body

  • Headache
  • Muscle tension or pain
  • Chest pain
  • Fatigue
  • Change in sex drive
  • Stomach upset
  • Sleep problems

Common Effects of Stress on Your Mood

  • Anxiety
  • Restlessness
  • Lack of motivation or focus
  • Feeling overwhelmed
  • Irritability or anger
  • Sadness or depression

Common effects of stress on your behavior

  • Overeating or under-eating
  • Anger outbursts
  • Drug or alcohol abuse
  • Tobacco use
  • Social withdrawal
  • Exercising less often

Act to manage stress

If you have stress symptoms, taking steps to manage your stress can have numerous health benefits. Explore stress management strategies, such as:

  • Regular physical activity
  • Relaxation techniques, such as deep breathing, meditation, yoga, tai chi or getting a massage
  • Keeping a sense of humor
  • Socializing with family and friends
  • Setting aside time for hobbies, such as reading a book or listening to music

Aim to find active ways to manage your stress. Inactive ways you may use to manage stress — such as watching television, surfing the Internet or playing video games — may seem relaxing, but they may increase your stress over the long term.

When to seek help

If you’re not sure if stress is the cause or if you’ve taken steps to control your stress but your symptoms continue, see your doctor. Your doctor may want to check for other potential causes. Or, consider seeing a professional counselor or therapist who can help you identify sources of your stress and learn new coping tools.

Also, if you have chest pain, especially if it occurs during physical activity or is accompanied by shortness of breath, sweating, dizziness, nausea, or pain radiating into your shoulder and arm, get emergency help immediately. These may be warning signs of a heart attack and not simply stress symptoms.
(Source: mayoclinic.org)

Some stress can be beneficial some of the time. Stress produces a boost that provides the drive and energy to help people get through situations like work deadlines or exams. Stress occurs when you perceive demands — such as work, school or relationships — exceed your ability to cope.  An extreme amount of stress can have health consequences, affecting the immune, cardiovascular and neuroendocrine and central nervous systems. Without proper stress management stress can also take a severe emotional toll.

Chronic stress can result in serious health conditions including anxiety, insomnia, muscle pain, high blood pressure and a weakened immune system if no stress management is done. Stress can contribute to the development of major illnesses, such as heart disease, depression and obesity, as research has shown.

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We help you by developing positive, healthy ways to manage stress as it occurs. Many of these negative health consequences can be reduced, or eliminated with stress management techniques that work for you and your individual needs.

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Self-Esteem

Sel-esteem Counseling Statesville - Iredell County NC
Self-esteem reflects an individual’s overall subjective emotional evaluation of his or her own worth. It is the decision made by an individual as an attitude towards the self. Self-esteem encompasses beliefs about oneself.  General self-esteem traits are as follows:
  • Confident
  • Consider ourselves valuable
  • Respect for ourselves
  • Exists on a continuum, from high to low
  • Low self-esteem is associated with self-doubt, self- criticism, social isolation, suppressed anger, and shame.
  •  Linked to several mental health conditions, including anxiety and depression.

Signs and Symptoms

  • Negative self-talk
  • Regard themselves critically and may feel a perpetual sense of failure or lack of accomplishment.
  • Constantly comparing themselves to others and criticizing themselves

Low self-esteem is also closely associated with the following conditions and experiences:

  • Codependency
  • Social anxiety
  • General anxiety
  • Shame
  • Depression
  • Inadequacy
  • Powerlessness
  • Physical, emotional, or sexual abuse
  • Perfectionism

Challenges to Self-Esteem

  • Self-esteem is learned in childhood, and certain experiences may interfere with its development.
  • Being subject to criticism or abuse from parents and caretakers
  • Missing out on experiences that would foster a sense of confidence and purpose.
  • Receiving little or no positive reinforcement for accomplishments
  • Being stigmatized for unusual appearance or behaviors,  race, class, social identity, or having a learning disability or physical impairment

In adulthood, even a well-developed self-esteem can be challenged by sudden life changes. These changes can include things such as:

  • Perceived failures
  • Losing a job or changing jobs
  • Ending an intimate relationship
  • Having legal or financial troubles
  • Struggling with addiction or substance abuse
  • Having children with emotional troubles, physical health concerns, or a host of other events that might cause us to question our worth or value.

Therapy can help put these events in perspective and enhance your strengths to increase resilience, social support, and hope.

Additional resource:

 

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Postpartum Depression

Counseling For Postpartum Depression in Statesville

Postpartum Depression

The birth of a baby can trigger a jumble of powerful emotions, from excitement and joy to fear and anxiety. But it can also result in something you might not expect — depression.

Many new moms experience the “postpartum baby blues” after childbirth, which commonly include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues typically begin within the first two to three days after delivery, and may last for up to two weeks.

But some new moms experience a more severe, long-lasting form of depression known as postpartum depression. Rarely, an extreme mood disorder called postpartum psychosis also may develop after childbirth.

Postpartum depression isn’t a character flaw or a weakness. Sometimes it’s simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms — and enjoy your baby.

Symptoms

Signs and symptoms of depression after childbirth varies, and they can range from mild to severe.

Postpartum baby blues symptoms

Signs and symptoms of baby blues, which last only a few days to a week or two after your baby is born, may include:

  • Mood swings
  • Anxiety
  • Sadness
  • Irritability
  • Feeling overwhelmed
  • Crying
  • Reduced concentration
  • Appetite problems
  • Trouble sleeping

    Postpartum depression symptoms

    Postpartum depression may be mistaken for baby blues at first — but the signs and symptoms are more intense and last longer, eventually interfering with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin later — up to six months after birth.

Postpartum depression symptoms may include:

  • Depressed mood or severe mood swings
  • Excessive crying
  • Difficulty bonding with your baby
  • Withdrawing from family and friends
  • Loss of appetite or eating much more than usual
  • Inability to sleep (insomnia) or sleeping too much
  • Overwhelming fatigue or loss of energy
  • Reduced interest and pleasure in activities you used to enjoy
  • Intense irritability and anger
  • Fear that you’re not a good mother
  • Feelings of worthlessness, shame, guilt or inadequacy
  • Diminished ability to think clearly, concentrate or make decisions
  • Severe anxiety and panic attacks
  • Thoughts of harming yourself or your baby
  • Recurrent thoughts of death or suicideUntreated, postpartum depression may
    last for many months or longer.
    (Source: mayoclinic.org)
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Divorce

Divorce Counseling Services Iredell County

Reasons that often lead to divorce:

There are numerous reasons marriages end in  divorce. The following reasons have been identified as some of the most common factors leading to divorce:

  • Lack of commitment
  • Infidelity.
  • Communication issues
  • Inequality in marriage
  • Physical and emotional abuse
  • Addiction issues
  • Unrealistic expectations
  • Financial difficulties/how money is managed

Predictors of Divorce:

  • Constant criticism with very little encouragement or positive communication
  • Lack of respect for spouse
  • Defensiveness.
  • Stonewalling (deliberate avoidance of interaction and discussion of problems) which often leads to difficulty in resolving arguments or disagreements.

    Therapeutic Interventions:

  • Therapy is usually done on an individual basis.
  • Goal of sessions can be to address symptoms related to guilt, fear, anxiety, depression and grief
  • Therapy can provide an objective and rational perspective and assists in developing coping skills to work through difficulties.
  • Therapy as a means of  learning more about themselves and come to see the life transition as an opportunity for growth and personal development.
  • Divorce may contribute to or exacerbate certain mental health conditions, such as depression, anxiety, or personality diagnoses.
  • Many people perceive divorce as a personal failure. Therapy can help one work through those feelings, make sense of the end of the marriage, and obtain a new perspective.
  • Individuals may learn more about what they require from a relationship and what they do not desire in a relationship, and they may, through therapy, discover more about their own nature and personal characteristics.Therapy for children whose parents are divorcing.
  • Because parents may often be consumed with their own feelings during a divorce, they might overlook the emotional state of their children, who may be confused or feel guilt, loss, pain, or abandonment.
  • Children may not be sure which parent they should “choose,” or be loyal to, and they might also worry that they are the cause of the divorce.
  • When parents are aggressive with each other, a child may feel even more fearful, and a child who often hears his or her parents argue about custody arrangements might feel as if he or she is unwanted by either parent, or as if he or she is to blame for the separation.
  • If family members are able to discuss their feelings they may be able to process their emotions more easily and better adjust to the changes.

Adjusting After Divorce

  • Recovering is a process.
  • Adjusting to changes that occur can take time.
  • Part of the process is often the recognition of newly divorced people, whether they initiated the divorce or not, that their lives and the lives of those around them have been profoundly affected by their situation.
  • Worries about financial solvency, employment, or housing may affect them.
  • Stress over losing friends or family members as a result of the divorce can also be difficult to deal with.
  • Parents may be emotionally overwhelmed by guilt as they consider what effects the divorce may have on their children.

These issues can often be worked through during the recovery process. An individual in therapy may be more able to discover necessary coping techniques that can help in the establishment of a new life, and the individual may have an easier time developing a healthy perspective on the divorce.

Therapy can also often provide people with a safe, encouraging, and empowering experience during what might, for some, be a difficult time.

Case Examples

  • Therapy for grief after divorce:  Mark and Linda, a couple in their early thirties who has no children, come in for marriage counseling, as they are considering separation. Linda wants to save the marriage, however, Mark is ready to leave. After two or three sessions, it becomes clear to all involved that Mark has made up his mind. The therapist helps the couple to talk about their relationship openly in such a way that Mark and Linda are both able to learn, grow as individuals, and prepare for separation. After the separation occurs, the therapist continues to work with Linda to help her manage her grief and begin moving forward as a single woman.
  • Divorce after a 30-year marriage:  Nathan, 59, enters therapy after divorcing his wife of 30 years.  Nathan’s children are grown.  He has been unhappy for years. He hoped the divorce would make him feel better, but instead finds that he is devastated by the loss. His wife, who had not wanted a divorce, now seems to Nathan “to be doing fine,” and this confuses him terribly. He even spoke to his wife about reconciling, but she was uninterested. Nathan thinks that is for the best, but he cannot seem to make the adjustment to being single. A therapist helps Nathan identify his fears about being single and then assists him in beginning to develop the skills and support system he needs to stay connected with people and feel hopeful about the future. Together, they identify the benefits of marriage that Nathan has chosen to give up and the benefits of being single that he can now enjoy. Nathan has also developed methods of getting in touch with his grief and his guilt surrounding the divorce, his positive feelings towards his ex-wife, and his fears about being able to stay connected with his children.

Our goal is to assist you in coping with the decision to remain in a marriage or leave.  Both, individual or couples therapy may also be used to address these goals.

 

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ADHD

ADHD Counseling

Attention- Deficit/ Hyperactivity Disorder (ADHD)

Signs and Symptoms

It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue and can cause difficulty at school, at home, or with friends.

A child with ADHD might:

  • daydream a lot
  • forget or lose things a lot
  • squirm or fidget
  • talk too much
  • make careless mistakes or take unnecessary risks
  • have a hard time resisting temptation
  • have trouble taking turns
  • have difficulty getting along with others

    Types of ADHD:

  • Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
  • Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
  • Combined Presentation: Symptoms of the above two types are equally present in the person.Because symptoms can change over time, the presentation may change over time as well.

    Treatments

    In most cases, ADHD is best treated with a combination of behavior therapy and medication. For preschool-aged children (4-5 years of age) with ADHD, behavior therapy, particularly training for parents, is recommended as the first line of treatment. No single treatment is the answer for every child and good treatment plans will include close monitoring, follow-ups and any changes needed along the way.

    If you are concerned about a child’s behavior, it is important to discuss these concerns with the child’s healthcare provider.

    Checklist: Signs and Symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD)

    This checklist describes the types of symptoms that a healthcare provider will ask about in the process of deciding whether a child has ADHD. You can use this checklist to help you start the conversation.

    Deciding if a child has ADHD is a process with several steps. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, sleep problems, and certain types of learning disabilities, can have similar symptoms.

    The American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth edition (DSM-5) is used by mental health professionals to help diagnose ADHD. The criteria are presented here in modified form in order to make them more accessible to the general public. They are listed here for information purposes and should be used only by trained healthcare providers to diagnose or treat ADHD.

    Simply fill out the child’s name, age and today’s date and then check off the signs or symptoms the child has shown.  Print and take the completed checklist to your child’s healthcare provider.
    (Source: Center for Disease Control and Prevention/ www.cdc.gov)

    https://www.cdc.gov/ncbddd/adhd/documents/ADHD-symptom-checklist.pdf

COVID-19 NOTICE:

Now scheduling Telehealth online video/phone sessions. This is a simple process that complies with HIPAA requirements to ensure privacy & security. Contact In The Garden Counseling for more information.