Quick Links to Resources

General Resources | Depressive Disorders  | Anxiety Disorders

Eating Disorders | ADD/ADHD  | Parenting and Behavioral Disorders

General Resources
 

San Diego County Crisis Team:

(619) 236-3339

(800) 479-3339

San Diego Psychological Association Referral Services:

(619) 291-3451

Child Abuse Hotline:

(800) 344-6000

Elder Abuse Hotline:

(800) 510-2020

Domestic Violence, Rape/Sexual Assault Hotline:

(858) 272-1767
 

Crime Victims Hotline:

(619) 688-9200

Domestic Violence INFOLINE:

(619) 239-9000
 

Battered Women's Services (24-Hour Hotline):

(619) 234-316

Alcoholics Anonymous Website

American Academy of Child & Adolescent Psychiatry

American Psychological Association

Depressive Disorders

What Are They?

Depression is a term that is widely used in daily language. People use it to mean a variety of feelings including sad, blue, down and mourning. In psychology, however, when the word depression is used, it has a very specific meaning. A psychologist talks about depression when a defined set of criteria is met. The following are some of the symptoms of depression:

• Sad or depressed moods most days, and most of the day

• Losing interest in activities or things that were previously interesting/pleasurable

• Sleep disturbances (either insomnia or sleeping too much)

• Appetite disturbances (losing appetite, or feeling hungry all the time without cues that you are full)

• Loss of energy or feeling tired all the time despite adequate sleep

• Feeling restless

• Concentration and attention problems

• Persistent feelings of worthlessness, guilt or hopelessness

• Thoughts about death or suicide

Depression can come about because of identifiable events, or in some cases may appear out of the blue. Most people can relate with having depressed moods, but this does not necessarily mean they have had a Major Depressive Episode. To be diagnosed with Major Depressive Disorder, some of the previously listed symptoms need to be present for a significant amount of time and lead to significant problems with daily functioning. At some point in their lives about 20% of people experience what psychologists call a Major Depressive Disorder. There are other psychological states that resemble depression or are part of the larger family of Depressive Disorders.

• Dysthymia occurs when someone experiences a lower grade of depression for a very long period of time (two years or more), without significant relief from the symptoms.

• Bereavement is the type of depression experienced as the result of death or grief.

• Seasonal Affective Disorder is a very specific form of depression that is associated with winter months and the loss of sunlight.

• Post Partum Depression occurs in some mothers and usually manifests itself within the first few months after giving birth, but can start up to a year after birth. It is often extremely disturbing to mothers, as it can interfere with their ability to bond with their children.

What to do:

If you or someone you know is experiencing any of the above symptoms the first step is to talk to a physician and make sure that there are no health related issues that may be causing these symptoms. Once medical illness has been ruled out, the next step is to see a psychologist. Depending on the severity and duration of your symptoms, individual or group psychotherapy may be able to provide you with relief by providing the tools to manage and overcome your symptoms. Sometimes, psychotherapy needs to be complemented with medication, at which point the best person to prescribe medications would be a psychiatrist.
 

Reference:

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition Text Revision. Arlington Virginia: Author.

Burns, David (1990). The Feeling Good Handbook. New York: Penguin Books.

Greenberger, Dennis  & Padesky, Christine, A. (1995). Mind Over Mood; Change How You Feel by Changing the Way You Think. New York: Guilford Press.
 

Useful Links and Resources:

The Kristine Brooks Hope Center: A non-profit organization dedicated to suicide prevention.

National Institute of Mental Health:  Depression

MedicineNet on Depression

American Academy Of Child and Adolescent Psychiatry:  Facts for Families with a Depressed Child

Post Partum Depression

Post Partum Health Alliance: A San Diego Based Organization

The American Psychological Association - Depression

The Suicide Hotline:  Available 24 hours a day 7 days a week 1.800.SUICIDE (1.800.784.2433)  

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Anxiety Disorders

What Are They?

We use a lot of different words to describe anxiety: worry, nervousness, stress, tension, panic, feeling overwhelmed, traumatized or wound-up. Stress is a part of daily life; everybody has their share of stress no matter how simple their life might seem. In psychotherapy we deal with stress when 1) it has become chronic, 2) it has become too intense for the types of events that people are dealing with, or 3) stress becomes so frequent or intense that personal coping skills are no longer effective. The difference between daily stress and clinical anxiety is level of functioning. Anxiety disorders are the number one health problem in the United States today. Although 15% of Americans deal with an anxiety disorder yearly, only a fraction of them get help. There is a wide array of anxiety disorders, some more common or better known than others.

Panic Disorder: A panic disorder occurs when someone has one or more panic attacks and becomes extremely worried about the panic attack for a long time after. Panic attacks are very frightening to most people, even though they tend to be fairly short (about 10 minutes or less). Common signs of a panic attack are:

• Feeling smothered or short of breath,

• Heart pounding or racing,

• Dizziness,

• Feeling faint,

• Trembling or shaking,

• Feeling of choking,

• Sweating, hot flashes,

• Nausea or abdominal distress,

• Feeling as if things were not real

• Numbness or tingling,

• Chest pains,

• Fears of going crazy or losing control or dying.

Most people will describe feeling an immense sense of dread and doom. The first few times panic attacks occur, they seem to come out of the blue. After awhile, many people will find that specific situations and events can trigger an attack. Out of fear of developing a new attack, people who suffer from panic attacks may start to avoid places that trigger anxiety, especially places from which they believe escape will be difficult. If taken to an extreme this can lead to something called agoraphobia (fear of public places). Panic disorder can appear at any age, but it usually first appears between late adolescence and mid 30s.
 

Generalized Anxiety Disorder (GAD): GAD is characterized by chronic and pervasive worry. Individuals who suffer from GAD are constantly anxious. They worry about a number of topics, and have little control over their worries: their safety, their family’s safety, bills, the house, dying, health, relationships, the news, etc. Their worry is long term, and it tends to generalize itself from one issue to another. People with GAD will also complain of difficulty concentration and focusing, irritability, feeling restless, fatigued, muscle tension and difficulty sleeping. GAD tends to occur in combination with mood disorders. It is very tiring, frustrating and overwhelming to worry constantly, and that can lead to depressed moods over time. 

Specific Phobias: Phobias are extreme fears. Individuals can have a variety of phobias; needle, blood, and animal phobias, and fear of small enclosed spaces (claustrophobia) are relatively well known. The difference between a phobia and a regular fear is that fear in a phobia is so strong, that that it interferes with routine functioning.  Direct exposure to the feared situation can elicit panic, tears, and outbursts. Most people recognize that their fear is irrational, but cannot shake it. Specific phobias are relatively common; they affect about 10% of the population.

Social Phobia: Formerly known as Social Anxiety Disorders. Like other phobias it is characterized by intense and persistent fear or anxiety. The feared situation is social interactions, especially ones in which there is a possibility of being embarrassed. People worry about appearing crazy or stupid, losing control publicly, or making mistakes. Some people with social phobias choose to isolate themselves; they restrict their social engagements as much as possible. Others may choose or are forced to engage socially. When faced with social situations, persons who suffer from social phobia will report feeling extremely anxious or fearful, they will think about the feared situation long before it is due, and their thoughts are marked by dread and anxiety. They might report common symptoms of anxiety such as tension, headaches, shortness of breath, feeling dizzy or detached, sweating and gastrointestinal distress.

Obsessive Compulsive Disorder (OCD): OCD is an anxiety disorder that has two main components. The first one is obsessions, which are persistent thought, beliefs or images that occur in an intrusive manner, and are often accompanied by significant anxiety or distress. The second component is compulsions, which are repetitive behaviors or rituals that the person feels they must do to reduce their anxiety or distress. Examples of obsessions include fears of being contaminated, fear of someone breaking in or of having left a light or the gas on. These thoughts intrude on all other thoughts throughout the day, and take considerable effort to ignore or change. Although most people who suffer from OCD recognize that their obsessions are excessive, they cannot control them. Compulsions are behaviors or rituals such as washing one’s hands, checking the doors, the lights or the locks, doing a sequence of behaviors in a specific order, which serve to temporarily reduce the anxiety and the obsessions. Time spent ruminating over the obsessions or performing these compulsions is considerable, up to several hours a day. OCD is quite rare. Recent studies have shown that 1.5-2.1% of Americans suffer from it annually.

Trauma Responses: There are two categories of trauma responses: Acute Stress Disorder and Post Traumatic Stress Disorder (PTSD). Both disorders occur following a significant trauma, one where the person either felt directly endangered, witnessed someone else being hurt, or learns about harm or trauma befalling a close friend or relative. The nature of the trauma may vary from one person to another. The symptoms that people experience, however, tend to be similar: 

• Recurrent distressing thoughts or images of the trauma

• Recurrent distressing dreams

• Acting or feeling as though the traumatic event was happening again.

• Extreme distress at the idea of being re-exposed to cues associated with the trauma

• Extensive efforts are made to avoid any stimulus associated with the trauma.

• Persistent state of hyperarousal

Children may also withdraw or become more oppositional, argumentative or disruptive. The main difference between Acute Stress Disorder and PTSD is the duration of the symptoms and the severity of the response. PTSD is a much more complex and significant disorder; symptoms must have lasted for over a month following the trauma, and more symptoms are required to meet the criteria for PTSD.

Chronic Stress and Your Body

Anxiety disorders can be very distressing. They affect our mind, our emotions and even our body. Stress can be reduced to a basic biological response, which is associated with a series of chemical and physiological changes in the brain and body. This response has been termed the fight, flight or freeze response – it is a primitive mechanism to prepare our bodies to face danger by either fighting off an aggressor or fleeing it (the freeze response is an anomaly, an over-contraction of muscles). Our brains activate the sympathetic nervous system which leads to the following: increased heart rate and oxygenation of the muscles, movement of blood from the extremities to larger muscle groups, increased rate of breathing, muscle contraction, slowing of the digestive system, sharper hearing and sight. All these responses prepare the individual to face the enemy. In the face of danger this is an adaptive and necessary response. It can, however, be quite overwhelming when there is no actual danger (such as in a panic attack) or if the stress response becomes a chronic one. Chronic stress can lead to headaches, muscle aches, reduced immune system functioning, sleep and digestive problems, as well as chronic fatigue.

What to do:

The good news is that anxiety as a whole is very amenable to psychotherapy. A number of interventions can be used both in the therapy room and in daily life to help reduce and even eliminate anxiety. Steps to improve anxiety include: revising how your mind perceives the world, facing fears (progressively, and therapeutically), and learning how to control your body’s physiologic reaction to anxiety. Deep breathing  (can we link this to the Relaxation 101 page) and relaxation techniques are a wonderful way to immediately address stress and are extremely effective if practiced regularly. Other steps one can take include the following: 1. Be aware of the events and people in your life that may be causing tension or worry, 2. Be aware of your body (sleep, tension, headaches, changes in appetite), 3. Be aware of your general mood and state (fatigued, irritable, easily brought to tears…), 4. Take action by trying to simplify your life as much as possible, by asking for help and support when necessary, by making sure you take time for yourself (at least 20 minutes a day should be selfish minutes), and by practicing relaxation on a daily basis. If stress and anxiety persist go see a professional. Psychologists can help you identify the source of your anxiety and teach you how to manage and confront it. In some cases anxiety can significantly affect functioning, and medication might be necessary. Talk about this with your psychologist or physician and get an appropriate referral to a qualified psychiatrist.

Reference:

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition Text Revision. Arlington Virginia: Author.

Bourne, Edmund J. (2000). The Anxiety and Phobia Workbook – Third Edition. Oakland: New Harbinger Publications.

Morris, Tracy L. & March, John S. (2004). Anxiety Disorders in Children and Adolescents – Third Edition. New York: The Guilford Press.

Useful Links and Resources:

American Institute of Stress

The National Institute for Mental Health - Anxiety

National Center for Post Traumatic Stress Disorder

Download Our Information On Anxiety

Eating Disorders
 

What Are They?

An eating disorder is a serious psychological condition that manifests itself through unhealthy eating behaviors. There are two main types of eating disorders: Anorexia Nervosa and Bulimia. Both fall along a continuum with Anorexia on one end, healthy eating behaviors in the middle, and Bulimia on the other end.

Anorexia Nervosa: Anorexia is characterized by a persistent unwillingness to maintain normal body weight or an intense fear of gaining weight. Individuals with Anorexia often experience significant distortions in how they perceive their body shape or size. 

In some cases Anorexia is easily identified, such as when a person's body weight is significantly below where it should be. In the early stages, however, Anorexia may not be noticeable, as one starts to lose weight or simply plateaus.

At all stages individuals with Anorexia:

• Are excessive preoccupation with their body shape and tone,

• Have irrational fears or significant anxiety at the thought of weight gain

• Might reduce their portions, refuse to eat certain foods, or lower their overall daily intake of food.

• May also use vomiting or laxatives to facilitate weight loss.

• Or use exercise in excess to control weight.
   

The disorder is mainly present in females (more than 90% of cases of Anorexia occur in females), and often starts around adolescence; however, the prevalence in males is increasing, and symptoms of Anorexia are increasingly found at younger ages. Lack of nutrition leads to loss of muscle mass, failure to thrive and grow, loss of menstrual periods, and deterioration in overall appearance (emaciation, loss of hair, increased down-like body hair, poor complexion, dry skin, etc.). Anorexia is a serious condition. Associated complications include abdominal pain, constipation, hypothermia (loss of body heat), hypotension, cardiovascular problems, anemia, osteoporosis, and loss of energy, tooth decay, and esophageal problems in persons who induce vomiting. In 10% of cases Anorexia and its complications can lead to death.
 

Bulimia: Like Anorexia, Bulimia is characterized by an unreasonable and excessive preoccupation with body image and food. In Bulimia, however, individuals will repeatedly (several times a week over the course of 3 months) go through eating binges.

Binges tend to occur in short periods of time (usually 2 hours at most), during which a person will eat unusually large amounts of food. The foods ingested during binges are generally high calorie foods that may reflect cravings for a specific nutrient such as carbohydrates. Binges are secretive, and people describe feeling out of control, shameful and sometimes even disconnected from their actions.

Another important feature of this disorder is the repeated use of inappropriate methods to prevent weight gain. The most commonly used method is induced vomiting after a binge (this is used by 80-90% of individuals).  Other methods include the use of laxatives and diuretics or excessive exercising. Most people who suffer from Bulimia are within average weight ranges.

Bulimia primarily occurs in adolescent and adult females (prevalence rates are 1-3% among females); the disorder is less common in males (one tenth of that in females). Bulimia can lead to several medical and physiologic complications. Frequent vomiting can lead to electrolyte imbalances (hypokalemia, hypochloremia) and hypothermia. It can also lead to loss of tooth enamel, cavities, and acid reflux problems. Chronic use of laxatives can lead to a dependence on laxatives for bowel movements to occur.

What To Do:

What to do if you or someone you love may have an eating disorder? Remember, this is a serious and complex condition. It is not just about food or weight, but rather it is a manifestation of other emotional or psychological issues through food and weight. That means that it is not as simple as just telling someone they should eat, or not eat, exercise more or take a break. The first step should be to make an appointment with a physician for a full physical examination to make sure that no permanent damage has been done to the body. The second step is to get help from an appropriately trained professional (psychologists, therapists, psychiatrists, registered dieticians). Not only is the person dealing with this disorder going to need support and guidance, but so will their family and loved ones. There are many different levels of care and many different approaches for helping people manage and overcome an eating disorder. The best treatment should be determined in collaboration with a professional.

References:

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition Text Revision. Arlington Virginia: Author.

Claude-Pierre, Peggy (1997). The Secret Language of Eating Disorders: How You Can Understand and Work to Cure Anorexia and Bulimia. New York, New York: Vintage Books.

Emery Normandi, Carol & Roark, Laurelee (1999). It’s Not About Food. New York, New York: Pedigree.

Levenkron, Stephen (2001). Anatomy of Anorexia. New York/London: W.W. Norton & Company.

Daw, Jennifer. Eating Disorders on the Rise: A Capitol Hill Briefing Call Attention to Eating Disorders. Monitor on Psychology, 32 (9). American Psychological Association Online. October 2001.

Useful Links About Eating Disorders:

The Academy for Eating Disorders

National Eating Disorder Association (NEDA)

National Association of Anorexia Nervosa and Associated Disorders (ANAD)

Eating Disorders Anonymous (EDA)

American Dietetic Association

Gürze Books provides a wide variety of titles dealing with eating and body image issues

Eating Disorder Referrals:

http://www.eating-disorder-referral.com

http://www.edreferral.com

General Information sources:

http://www.helpguide.org/mental/eating_disorder_treatment.htm

http://www.nlm.nih.gov/medlineplus/eatingdisorders.html

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Attention Deficit Hyperactivity Disorder (ADD/ADHD)

What is it?

Attention Deficit Hyperactivity Disorder (ADHD) is a disorder that starts in childhood. It has two major categories of symptoms: inattention and hyperactivity-impulsivity. The inattention and impulsivity may exist together, or may be separate. When inattention is present on its own we call it Attention Deficit Disorder (ADD) rather than ADHD. In most individuals, when impulsivity is present, it goes hand in hand with inattention. A key feature of ADHD or ADD is that the symptoms must be present before the age of seven, and must be causing significant problems with daily functioning.

Inattention:

• Difficulty focusing or concentrating on tasks,

• Failing to pay attention to details,

• Frequently and easily losing interest in what one is doing,

• Disorganization,

• Constantly loosing things,

• Seemingly not paying attention when spoken to,

• Becoming easily distracted by one's environment.

These are the symptoms that parents or teachers of children with ADD, or ADHD typically report.

Hyperactivity- Impulsivity:

• Constant fidgeting,

• Difficulty staying seated or being still for prolonged periods of time,

• Feeling restless,

• Excessive talking,

• Rambunctious play or trouble playing quietly or calmly.

Impulsivity leads to problems waiting for one's turn, blurting out questions or answers, interrupting others, or acting without thinking through the consequences.

All of these behaviors are common to childhood and growing up. Some children are high energy, while some are more easily bored than others. Individually none of these behaviors is problematic. We consider a child or an adult to have ADD or ADHD when they have several of these behaviors/symptoms, and the presence of these issues interfere their functioning. Children with ADHD/ADD are often mislabeled as oppositional, lazy, unmotivated, or simply poor students.

How it can affect you?

ADHD/ADD is best known for its impact on academic and occupational functioning. Often poor grades or disruptive behaviors in class lead to referrals for ADD/ADHD evaluations. There are other complications that can result or appear in conjunction with ADD/ADHD such as poor peer relationships, parent-child relationship issues, behavioral problems, drug use in adolescence and depression.

What to do:

What can you do if you or someone you know has ADD/ADHD? The first step is to get evaluated. There are many psychological and physical issues that can look like ADD/ADHD; therefore, it is important to get a good history and a clear picture of what is going on before labeling someone with a diagnosis. If the diagnosis is confirmed there are many avenues for treatment. It is important to remember that people with ADD/ADHD aren't trying to get away with anything, they are not purposefully forgetting things or acting out; they have more difficulty controlling their attention and their energy than someone without these issues.

Parents of children with ADD/ADHD need as much help as the child. Structure, behavior modification plans and parenting are recommended clinical approaches. A psychologist can work with families and schools to create an individualized plan for managing and improving attention and hyperactivity-impulsivity. In some cases, structure and behavior modification alone will not work and medication may be recommended. The best person to talk to about medication is a psychiatrist. Both medications and psychotherapy are effective tools to treat ADD/ADHD, medications decrease hyperactivity and psychotherapy teaches skills to manage behavior.

Additionally, if these issues have gone unmanaged for a long time, there might be other complications such as strained relationships, depressive features (academic failure and constant arguing can lead individuals to think of themselves as stupid, hopeless, bad), or social skill deficits, these all need to be addressed.

The good news:

ADD/ADHD is amenable to psychotherapy. Furthermore, many individuals grow out of it or learn to compensate for their deficits. By adulthood 50% of individuals who were diagnosed with ADD/ADHD no longer meet criteria.

References:

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition Text Revision. Arlington Virginia: Author.

Hoza et al. (2005). What Aspects of Peer Relationships Are Impaired in Children With Attention-Deficit/Hyperactivity Disorder? Journal of Consulting and Clinical Psychology, 73 (3), 411-423.

Fowler, Raymond D., Ph.D. Testimony of the American Psychological Association for the hearing record of the House Committee on Government Reform: Attention Deficit Disorder/Hyperactivity Disorders? Are Children Being Over Medicated? September 26, 2002.

Molina, B. S.G. & Pelham, W.E. Jr. (2003). Childhood Predictors of Adolescent Substance Use in a Longitudinal Study of Children With ADHD.  Journal of Abnormal Psychology, 112 (3) 497-507.

Useful Links and Resources:

Attention Deficit Disorder Association

Children and Adults with Attention Deficit/Hyperactivity Disorder

Learn About Our Parenting Seminars

Parenting and Behavioral Disorders

Parenting is tricky. Many people feel like they should innately know how to parent their children. The truth is there are probably aspects of parenting that are innate; biologically we are designed to feel bonded towards our children. A hormone called oxytocin is partly responsible for the immediate attraction we have towards babies and children. Oxytocin also facilitates production of breast milk and enhances contractions during birth. Part of parenting, however, is a learned process. We learn from our parents what to do, and what not to do. A third part of parenting is based on situational factors; different temperaments call for different parenting styles. Because parenting behaviors are multi-faceted, they are complicated and therefore not necessarily easy to figure out or implement. Over the years there have been many different schools of thought about parenting; some are focused on making sure that children do not get spoiled, while others are especially focused on preserving and enhancing the attachment process between parent and child.

The parenting philosophy and methods you use need to be adapted to children’s individual personalities and life circumstances. Some children only need to be told something once, and they do it. Some children hardly argue. Some children are calm and quiet. Other children are talkative, ask a thousand questions and get into everything. Some children argue, don’t like schedules, and always say no before they say yes.  How we parent our children affects how they respond to us. There are other factors too that may impact your child’s behavior. Children who are under stress, not feeling well or are anxious, hurt or angry are more likely to act out. Acting out and tantrums are not simply a sign of oppositionality or being spoiled.

There are a few principles that can be universally applied to all types of children. 1) Set expectations for your children that are developmentally appropriate. 2) Express those expectations in clear and age-appropriate terms to your child. 3) Set consequences that are appropriate for the limits – consequences should be both positive if the expectations are met, and negative if they are not. 4) Try to make sure your consequences flow naturally from the expectation. 5) STAY CONSISTENT – children need to know what to expect. Inconsistent rules and expectations can confuse children and create distress.

Useful Links and Resources on Parenting and Behavioral Disorders:

American Psychological Association Resources on Parenting

Medline Plus - Child Behavioral Disorders

Medline Plus - Parenting

WebMD: Parenting

Phelan, Thomas (1995). 1-2-3 Magic: Effective Discipline for Children 2-12.Glen Ellyn, Illinois: Child Management Inc.

Severe, Sal (2000). How to Behave So Your Children Will, Too! New York, New York: Penguin Putnam Inc.

Learn About Our Parenting Workshops and Seminars