Common Concerns

Please note that the following list is meant to be used as a guide and should not be used to diagnose oneself or others. Assignment of a psychological diagnosis is complicated, involves a great deal of thought and information and should be conducted only by trained professionals.

Anger is a completely normal, usually healthy, human emotion. But when it gets out of control and turns destructive, it can lead to problems. These may include problems at work, in personal relationships, and in overall quality of life. Individuals may have difficulty controlling their anger responses and turn small problems like traffic or misunderstandings with a spouse into a highly charged emotional disturbance. The goal of anger management is to reduce both emotional feelings and the physiological arousal that anger can cause. Individuals may not be able to avoid the things or the people that enrage them, nor can they change them, but they can learn to control their reactions. A psychologist can work with individuals to understand the roots of their anger and develop a range of techniques for changing thinking and behavior when confronted with anger-producing situations. Techniques that improve coping and problem solving skills have proven effective in managing anger and its associated consequences.

Attention Deficit/Hyperactivity Disorder (ADHD) limits the capacity to sustain focus in often highly creative and energetic individuals. ADHD is characterized by symptoms related to inattention and/or impulsivity for a duration of at least six months. Some of the symptoms should have been present before age 7. Individuals with ADHD are easily distracted and are often disorganized. They may misplace or lose things necessary for important tasks and they are forgetful in daily activities. Some people with ADHD experience hyperactivity or impulsivity. They may fidget and squirm or feel like they are always on the go. They may talk out of turn or interrupt conversations without being aware. Because individuals with ADHD often have varied interests, they can be quite creative. However they may have difficulty following through with their ideas unless they harness their energy and apply some organizational skills. Research has shown that individuals with ADHD generally have under-arousal in certain parts of the brain. In addition to cognitive-behavioral therapy to increase organization, reduce distraction, and improve attention, stimulant medication like Ritalin may be prescribed to counter the under-arousal and help the individual function better.

The pervasive developmental disorders, or autism spectrum disorders, range from a severe form, called autistic disorder, to a milder form, Asperger’s syndrome. If a child has symptoms of either of these disorders, but does not meet the specific criteria, the diagnosis is called pervasive developmental disorder not otherwise specified (PDD-NOS). Other disorders that are included in the autism spectrum disorders are Rett’s disorder and childhood disintegrative disorder. All children with Autistic Spectrum Disorders demonstrate deficits in (1) social interaction, (2) verbal and nonverbal communication, and (3) repetitive behaviors or interests. In addition, they will often have unusual responses to sensory experiences, such as certain sounds or the way objects look. Each of these symptoms runs the gamut from mild to severe. They will present in each individual child differently. Children with Autism Spectrum Disorders do not follow the typical patterns of child development. In some children, hints of future problems may be apparent from birth. In most cases, the problems in communication and social skills become more noticeable as the child lags further behind other children the same age.

When people are ill with bronchitis or the flu, they know that they will be feeling better and functioning normally within a week or so. A chronic illness is different. A life threatening illness may never go away and will disrupt an individual’s lifestyle in many ways. Pain and fatigue may become a frequent part of the day. Physical changes from a disease process may occur and affect appearance and diminish positive self-image. When individuals with chronic illnesses feel hopeless and discouraged, they may prefer isolation and withdraw from friends and social activities. Chronic illness can also influence the ability to function at work or school. A psychologist can create a treatment plan to help decrease symptoms of anxiety and depression, regain a sense of control, and improve quality of life. By participating in individual counseling, individuals may more effectively express sensitive or private feelings they have about illness and its impact on lifestyle and relationships. Children at different ages and levels of understanding will experience varied challenges based on their developmental level. Children experiencing chronic medical illness should receive psychological care that is targeted to their developmental level. When a child or family member is diagnosed and treated with a chronic illness, the entire family is affected and may benefit from psychotherapy to help them adjust to the demands of undergoing or watching a loved one receive treatment. Siblings of children with chronic illnesses should be evaluated for adjustment difficulties, as they are often left in the shadow of ill siblings and may suffer long term consequences that go unnoticed.

Depression is a pervasive and damaging illness characterized by a sad or empty mood, feelings of hopelessness and/or worthlessness, and by a pattern of negative thinking. It is frequently accompanied by physical symptoms which do not respond to treatment and by slowed motor behavior. There are three main types of depressive disorders which include (1) major depression, (2) dysthymia, and (3) bipolar disorder, sometimes known as “manic-depression”. These disorders differ from each other in the number, severity, persistence, and type of symptoms experienced.

Major depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. A severely disabling episode of depression may occur only once but may more commonly repeat several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, over-talkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated and be full of grand schemes that might range from unwise business decisions to romantic sprees.

Postpartum depression may also be an important time to seek psychotherapy. Following pregnancy or childbirth, women may face debilitating depressive symptoms which are complicated by sleep deprivation and the demands of caring for an infant. Women may feel overwhelming isolation and fear at a time when others assume they should be joyful. The stigma and shame of postpartum depression may prevent women from obtaining needed therapies and result in deepening depression and devastating consequences. Recently the New Jersey State Government has encouraged the destigmatization of postpartum depression and related treatment. We cannot overstate the need for quality, immediate treatment of this serious problem.

Depressive disorders may appear differently in adults and children. Whereas adults may feel sad or numb, avoiding others and/or activities, children may display anger, act out, and poor school performance. Often, childhood depression does not have an obvious presentation, requiring a trained professional to make the diagnosis.

Certain disorders beginning in infancy and childhood are characterized by a failure to meet normal developmental milestones. Youth who have been noted to lag behind their peers in more than one area and who lack age appropriate self-care skills may be diagnosed with a developmental disorder. Parents and families may also suffer when a child receives such a diagnosis. In conjunction with a developmental pediatrician, a psychologist can determine an appropriate plan for attaining reasonable goals and helping these children and families achieve the highest possible quality of life. Educational advocacy for these children may be needed and may be accomplished by securing the most appropriate educational assessment and forming successful relationships between families and schools. We recommend an interdisciplinary approach for children with developmental disorders and are well versed in working with other contributing professionals.

Fertility issues are any factors affecting the ability to conceive (become pregnant). Infertility is the inability to create or sustain a pregnancy after one year of consecutive attempts. This includes recurrent miscarriage and can apply to both women and men. While undergoing fertility treatment many couples tend to live in month-to-month cycles of hope and disappointment that revolve around ovulation calendars and menstruation. As they navigate a tight schedule of tests and treatments, they place their lives on hold – postponing vacations, putting off education, and short-circuiting their careers. Others find that the sorrow, anger, and frustration that can come with prolonged fertility problems invade every area of life, eroding self-confidence, and straining friendships. Studies show that, as a group, women with fertility problems can be as anxious and depressed as women with cancer, heart disease, or HIV. One reason for this may be the physical demands of fertility treatments – blood tests, pills, daily hormone injections, ultrasounds, egg retrievals, and surgery can all be a source of stress and emotional upheaval in women. Also, society often fails to recognize the grief caused by fertility problems, so people denied parenthood tend to hide their sorrow, which only increases their feelings of shame and isolation.

Generalized anxiety disorder (GAD) is much more than the routine anxiety people experience day to day. It is made up of chronic and exaggerated worry and tension, seemingly without cause. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. The source of the worry may be hard to pinpoint. Simply the thought of getting through the day provokes anxiety. People with GAD cannot seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. People with GAD also seem unable to relax. They often have trouble falling or staying asleep. Their worries are accompanied by physical symptoms, especially trembling, twitching, muscle tension, headaches, irritability, sweating, or hot flashes. They may feel lightheaded or out of breath. Many individuals with GAD startle more easily than other people. They tend to feel tired, have trouble concentrating, and sometimes suffer from depression. The impairment associated with GAD may take the form of nausea, frequent trips to the bathroom or feeling like there is a lump in the throat. GAD comes on gradually and most often hits people in childhood or adolescence, but can begin in adulthood, too. It is more common in women than in men and often occurs in relatives of affected persons.

The loss of a loved one is life’s most stressful event and can cause a major emotional crisis. After the death of a loved one, individuals experience bereavement, which literally means “to be deprived by death.” When a death takes place, an individual may experience a wide range of emotions, even when the death is expected. Many people report feeling an initial stage of numbness after first learning of a death, but there is no real order to the grieving process. Some emotions you may experience include disbelief, confusion, shock, sadness, anger, guilt, and despair. Many people also report physical symptoms that accompany grief. Stomach pain, loss of appetite, sleep disturbances and loss of energy are all common symptoms of acute grief.

Obsessive-compulsive disorder (OCD) is a potentially disabling anxiety disorder. The person afflicted with OCD becomes trapped in a pattern of repetitive, overwhelming, sometimes senseless thoughts and behaviors that are very difficult to overcome. A person’s level of OCD can be anywhere from mild to severe, but if severe and left untreated, it can destroy a person’s capacity to function at work, at school or even to lead a comfortable existence in the home. Although OCD symptoms typically begin during the teen years or early adulthood, research shows that some children may even develop the illness during preschool. Studies indicate that at least one-third of cases of adult OCD began in childhood. Suffering from OCD during early stages of a child’s development can cause severe problems for the child. It is important that the child receive evaluation and treatment as soon as possible to prevent the child from missing important developmental opportunities.

Chronic and recurrent pain problems are a common source of distress which can affect both adults and children and severely impact functioning. Frequently we work in conjunction with the client’s medical practitioner to provide appropriate education about chronic pain and then utilize cognitive-behavioral strategies which enable clients to cope more effectively with pain and return them to more acceptable levels of functioning.

Panic disorder is characterized by un-expected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness or abdominal distress. These sensations often mimic symptoms of a heart attack or other life-threatening medical conditions. As a result, the diagnosis of panic disorder is frequently not made until extensive and costly medical procedures fail to provide a correct diagnosis or relief. Many people with panic disorder develop intense anxiety between episodes. It is not unusual for a person with panic disorder to develop phobias about places or situations where panic attacks have occurred, such as in supermarkets or other everyday situations. As the frequency of panic attacks increases, the person often begins to avoid situations where they fear another attack may occur or where help would not be immediately available. This avoidance may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety. Children may develop panic disorder as well as adults, and may become avoidant of school or other age appropriate situations.

Child behavioral problems and parenting questions often go hand-in-hand. Although behavioral issues and limit setting concerns are part of every parent’s experience, there may be times when parents have additional questions, doubt their strategies, or wish to change their children’s problematic behavior to increase family harmony. Experienced cognitive-behavioral psychologists are skilled at assisting parents with new approaches to improve their children’s behavior by using a combination of reinforcement strategies and your parenting styles and strengths. No behavioral plan will work without consistency across caregivers or appropriate consideration of the disciplinary philosophy of the parents. We are well aware of the burdens placed on modern families and wish to provide simple and effective assistance for parents.

Post-Traumatic Stress Disorder can occur when individuals are exposed to a traumatic event that threatened death or serious injury to themselves or others. An individual diagnosed with PTSD re-experiences the traumatic event in one or more ways, which may include images of the event, dreams, feeling the event may be recurring, flashbacks, etc. The individual also avoids situations or stimuli that are likely to remind them of the traumatic event and he or she may sense a feeling of detachment from others or normal life that was not present before the traumatic event. Finally, the individual is likely to experience symptoms of hyperarousal that may cause difficulty sleeping, irritability, poor concentration, hypervigilance, and increased startle response. In children, symptoms may also include regression to more immature behaviors or a younger developmental level.

At various points in people’s lives, they may find that they are having difficulty forming or sustaining existing relationships. This may be the result of any of the above mentioned difficulties or it may be a function of the relationship, itself. A trained psychologist will do a functional analysis of the relationship problem and related behavior. In this way, causal factors may be identified and a plan of action can be developed to improve quality of life and connection to others.

Repetitive Behaviors like nail biting and hair twirling are common in adulthood and childhood. When the problem becomes excessive or unhealthy, cognitive-behavioral therapy can often be helpful in reducing symptoms. If clients are motivated to stop these behaviors they can often significantly reduce their habit using thought strategies and relaxation methods.

A child with school phobia is a child who misses a great deal of school because of vague physical symptoms. The symptoms are usually the type that people get when they are upset or worried, and may include stomachaches, headaches, nausea, vomiting, diarrhea, tiredness, or dizziness. These physical symptoms mainly occur in the morning, and they worsen when it is time to leave for school. The child my also have trouble falling asleep the night before a test or other stressful event. A school-phobic child is usually afraid of leaving home in general, rather than afraid of anything in particular at school. Aside from poor attendance, these children usually are good students and well behaved at school.

Selective mutism is a complex childhood anxiety disorder characterized by a child’s inability to speak in select social settings. Children diagnosed with selective mutism understand language and are able to talk normally in settings where they are comfortable, secure and relaxed. Over 90% of children with selective mutism also have social phobia or social anxiety, and some experts view selective mutism as a symptom of social anxiety. Children and adolescents with selective mutism have an actual fear of speaking and of social interactions where there is an expectation to talk. They may also be unable to communicate nonverbally, may be unable to make eye contact and may stand motionless with fear as they are confronted with specific social settings. A majority of children with selective mutism have not, contrary to assumptions, experienced a traumatic event, and instead, are simply fearful about verbal interactions with others.

Separation anxiety refers to a developmental stage during which the child experiences anxiety when separated from the primary care giver (usually the mother). It is normal between 8 months of age and may last until 14 months old. In young children, their unwillingness to leave a parent or a caregiver is a sign that attachments have developed between the caregiver and child. They are beginning to understand that each object (including people) in the environment is different and permanent. Young children cannot yet understand time so they do not know when or even if you will ever come back. Children at this stage are struggling between feelings of striking out on their own and yet wanting to stay safe by a parent or caregiver’s side. Although separation anxieties are normal among infants and toddlers, they may be damaging when they occur in older children or adolescents and may represent symptoms of separation anxiety disorder.

Sleep difficulties are a common problem for both children and adults. Problems may include insomnia, nightmares, fear of the dark, and reluctance to sleep alone. A good night’s sleep is often the cornerstone of healthy physical and psychological functioning. Poor sleep habits are correlated with many psychological problems and are likely to cause symptoms that may include irritability, concentration difficulties, restlessness, and anxiety. Cognitive-behavioral therapy approaches work to improve sleep difficulties by identifying and changing behaviors that contribute to poor sleep. Individuals can quickly learn thought strategies that help them reduce worries that may keep them awake at night. They may also benefit from relaxation training that teaches them to reduce physical stress that is correlated with poor sleep. When children experience sleep problems the entire family is affected. For children experiencing sleep difficulties, intervention is often done with parents to alter unhelpful patterns that may contribute to the problem. In addition, childhood sleep problems like night terrors and sleepwalking may be made worse by lack of sleep. Techniques like scheduled awakening can reduce incidences of night terrors and result in improved sleep for the whole family.

Social phobia, previously called Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. People with social phobia have a persistent, intense, and chronic fear of being watched and judged by others and of being embarrassed or humiliated by their own actions. Their fear may be so severe that it interferes with work, school, or other activities. While many people with social phobia recognize that their fear of being around people may be excessive or unreasonable, they are unable to overcome it. They often worry for days or weeks in advance of a dreaded situation. In addition, they often experience low self-esteem and depression. Social phobia can be limited to only one type of situation — such as a fear of speaking in formal or informal situations, or eating or drinking in front of others — or, in its most severe form, a person experiences symptoms whenever they are around other people. If left untreated, social phobia can have severe consequences. For example, it may keep people from going to work or school. Many with this illness are afraid of being with people other than family members. As a result, they may have a hard time making and keeping friends. Physical symptoms often accompany the intense anxiety of social phobia and include blushing, profuse sweating, trembling, and other symptoms of anxiety, including difficulty talking and nausea or other stomach discomfort. These visible symptoms heighten the fear of disapproval, and the symptoms themselves can become an additional focus of fear. Fear of symptoms can create a vicious cycle: as people with social phobia worry about experiencing the symptoms, the greater their chances of developing the symptoms. Adults and children may be diagnosed with this disorder and, as it may become worse over time, it is important to seek treatment as soon as possible.

Specific Phobia is characterized by the excessive fear of an object or a situation, exposure to which causes an anxious response, such as a panic attack. Individuals with phobias recognize that their fear is excessive and unreasonable, but they are unable to control it. The feared object or situation is usually avoided or anticipated with dread. Specific Phobia is diagnosed when an individual’s fear interferes with their daily routine, employment (e.g., missing out on a promotion because of a fear of flying), social life (e.g., inability to go to crowded places), or if having the phobia is significantly distressful. The level of fear felt by the sufferer varies and can depend on the proximity of the feared object or chances of escape from the feared situation. Specific Phobia may have its onset in childhood, and is often brought on by a traumatic event; being bitten by a dog, for example, may bring about a fear of dogs. Phobias that begin in childhood may disappear as the individual grows older or they may worsen, requiring cognitive-behavioral treatment.

Research suggests that medical issues which were previously thought to solely affect physical functioning frequently have a psychological component as well. There is vast potential for psychological interventions in these traditionally medical areas: irritable bowel syndrome, hypertension, headache, asthma, dermatological disorders, Raynaud’s disease and phenomenon, rheumatoid arthritis, temporomandibular disorders, diabetes mellitus, and premenstrual syndromes. Cognitive-behavioral approaches have been very successful reducing both psychological and medical symptoms related to these types of disorders by providing an understanding of mind-body connections, teaching self-regulatory strategies such as relaxation skills, and helping clients to think differently about situations they encounter.

Elimination disorders occur in children who have problems going to the bathroom — both defecating and urinating. Although it is not uncommon for young children to have occasional “accidents,” there may be a problem if this behavior occurs repeatedly for longer than 3 months, particularly in children older than 5 years. There are two types of elimination disorders, encopresis and enuresis. Enuresis refers to the involuntary discharge of urine. Three types of enuresis exist: diurnal (wetting during the day), nocturnal (wetting during the night), and mixed (wetting during both daytime and nighttime). Encopresis is the passage of feces into places that are inappropriate and include both intentional and involuntary actions. Children with enuresis or encopresis are at risk for emotional and social problems related to the condition, such as low self-esteem, depression, school difficulties, and problems socializing with other children, including not wanting to go to parties or to attend events requiring them to stay overnight. Often encopresis is the result of constipation and subsequent withholding of stool. Cognitive-behavioral treatment can be very helpful in treating children with constipation-related encopresis by teaching about the manner in which the body produces stool, improving dietary intake, and introducing appropriate toilet sitting with a positive and non-punishing approach.