About Dr. Berman

DIAGNOSES / WHO CAN BE HELPED?

Depression

Anxiety Disorder

Panic Disorder

Adjustment Disorder

Dysthymia

Bipolar Disorder

Personality Disorders (including Borderline Personality Disorder)

Obsessive Compulsive Disorder

Post-partum Depression

Attention Deficit/Hyperactivity Disorder

Eating Disorders

Substance Abuse

Social Phobia (Social Anxiety Disorder)

Acute Stress Disorder

Post-Traumatic Stress Disorder

 

Depression
A major depressive episode is defined as a prominent and relatively persistent depressed or unhappy mood, which occurs nearly every day for at least 2 weeks, and typically interferes with daily functioning.
At least 5 of the following 9 symptoms are present:
· depressed mood throughout most of the day
· loss of interest or pleasure in usual activities
· significant change in weight and/or appetite (either increase or decrease in weight or appetite)
· changes in sleep pattern (either insomnia or increased sleep)
· either physical agitation or slowing down
· fatigue or decreased level of energy
· feelings of guilt or worthlessness
· decreased ability to think or concentrate, or an increase in indecision
· thoughts of death or suicide or suicide attempts

Also see dysthymia or adjustment disorder

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Anxiety Disorder
Generalized anxiety disorder is defined as excessive anxiety and worry, which is present more days than not, for at least 6 months. The anxiety is difficult to control and causes significant distress or impairment in normal functioning.
At least 3 of the following 6 symptoms are present:
· restlessness or feeling keyed up or on edge
· being easily fatigued
· difficulty concentrating or mind going blank
· irritability
· muscle tension
· sleep disturbance (difficulty falling or staying asleep or restless, unsatisfying sleep)

Also see panic attacks, social anxiety disorder, acute stress disorder, post-traumatic stress disorder, adjustment disorder.

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Panic Attacks
A panic attack is a discrete period of intense fear or discomfort that develops abruptly and typically peaks in 10 to 15 minutes and often resolves after 30 minutes, though discomfort may persist for longer. Panic attacks are often misinterpreted as a physical problem since a frequent sensation is that one is dying, or "something feels very wrong," and panic attacks not infrequently lead to emergency room visits before they are diagnosed.
Four or more of the following symptoms are present:
· palpitations, pounding heart, or rapid heartbeat
· sweating
· trembling or shaking
· shortness of breath or inability to catch breath
· sensation of choking
· chest pain or discomfort
· nausea or abdominal distress
· feeling dizzy, unsteady, lightheaded, or faint
· feelings of unreality or detachment from oneself
· fear of losing control or going crazy
· fear of dying
· numbness or tingling sensation
· chills or hot flushes

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Adjustment Disorder
An adjustment disorder entails the development of emotional or behavioral symptoms in response to an identifiable stressor occurring within three months of the onset of the stressor.
There is marked distress that is in excess of what would be expected from exposure to the stressor, and there is significant impairment in social or occupational functioning.
Once the stressor has terminated, the symptoms resolve within six months (or a diagnosis of depression, anxiety disorder, or other is made).
Predominant symptoms of adjustment disorders may be depressed or anxious mood or both.

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Dysthymia
Dysthymic disorder is defined as depressed mood for most of the days, for more days than not for at least two years.
In addition to depressed mood, there are at least two of the following symptoms:
· poor appetite or overeating
· insomnia or increased sleep
· low energy or fatigue
· low self-esteem
· poor concentration or indecision
· feelings of hopelessness

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Bipolar Disorder (Manic-Depression)
Bipolar disorder is a serious illness that causes unusually extreme shifts in a person's mood, energy, and ability to function. These shifts are different from the normal ups and downs that everyone goes through. The mood swings of bipolar disorder are dramatic--from overly "high" and/or irritable manic episodes to sad and hopeless depressive episodes, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood.

A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week. There is often poor judgment and denial that anything is wrong. Three or more of the following symptoms are present (if mood is irritable rather than elevated, four additional symptoms must be present):
· Inflated self-esteem or grandiosity (including unrealistic beliefs in one's abilities and powers)
· Decreased need for sleep
· More talkative than usual or talking more rapidly than usual
· Feeling that thoughts are racing, or jumping from topic to topic
· Distractibility
· Increased energy and activity and/or agitation
· Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. unrestrained buying sprees, sexual indiscretions, foolish business investments, excessive gambling).

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity, thus the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania or can switch into depression.

A mixed episode may also occur, in which the criteria are met for both a manic episode  and a depressive episode. Psychotic symptoms may also be present in either depressed or manic episodes and include paranoia, auditory or visual hallucinations, and delusions.

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Post-Traumatic Stress Disorder and Acute Stress Disorder
In these disorders, there has been exposure to a traumatic event in which one experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury or threat to the physical integrity of self or others, and the person's response involved fear, helplessness, or horror.

In acute stress disorder, the disturbance lasts at least 2 days and no more than 4 weeks following the event. Either during or after the event, there dissociative symptoms including sense of numbing or detachment or absence of emotional response, feeling "in a daze," a sense of unreality, a sense of detachment from oneself, and amnesia for important aspects of the event. The event is persistently reexperienced through recurrent images, thoughts, dreams, illusions, flashbacks, or a sense of reliving the experience. There is an avoidance of stimuli that arouse recollections of the event, and there are marked signs of anxiety or increased arousal such as difficulty sleeping, irritability, poor concentration, hypervigilence, exaggerated startle response, and restlessness.

Acute stress disorder may predispose to post-traumatic stress disorder.

In post-traumatic stress disorder, the disturbance persists for more than one month. The event is persistently reexperienced in one or more ways, including recurrent and intrusive distressing recollections of the event, recurrent distressing dreams of the event, acting or feeling as though the event were recurring, intense distress (psychological or physical) at exposure to internal or external cues that symbolize or resemble an aspect of the event. There is persistent avoidance of stimuli associated with the trauma and a numbing of responsiveness (may even include a sense of a foreshortened future). As with the acute stress response, there are persistent symptoms of anxiety or increased arousal.

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Social Anxiety Disorder (Social Phobia)
Social anxiety disorder consists of a marked and persistent fear of social or performance situations in which one is exposed to unfamiliar people or possible scrutiny by others. The individual fears that he or she will act in a way that will be humiliating or embarrassing. Exposure to the feared situation provokes anxiety (possibly even a panic attack), and the person recognizes that the fear is excessive. The feared situations are either avoided or endured with intense anxiety, and there may be marked distress about having the phobia.

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Obsessive Compulsive Disorder
Obsessive compulsive disorder is a disorder that causes people to have either obsessions or compulsions, or both. People with OCD usually are aware that their behaviors and thoughts are excessive and are often ashamed of them, sometimes going to extremes to avoid revealing their embarrassing rituals.

Obsessions as defined by (1), (2), (3), and (4):
1. recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
2. the thoughts, impulses, or images are not simply excessive worries about real-life problems
3. the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
4. the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

Compulsions as defined by (1) and (2):
1. repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts ( e.g., praying, counting, repeating words silently) that the person 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 distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive

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Post-Partum Depression
Having a baby is the most significant life change most women will ever experience. This change, coupled with the major hormonal shifts that happen after delivery, makes the post-partum period a time when depression often strikes. A spectrum of mood disorders can commonly occur during this period, ranging from the very common post-partum “blues” to full-blown depression, as well as post-partum anxiety disorders and post-partum psychosis. Up to 85% of women experience some type of mood disturbance during this period and as many as 15% go on to develop a post-partum depression or anxiety.

The symptoms of post-partum depression are essentially the same as depression that occurs during any other time of life, but post-partum depression is particularly significant because of its timing in that it occurs within the first year after giving birth. This is significant not only because of the biological causes (i.e. hormonal shifts), but also because of the environmental causes (i.e. the stress of having a newborn baby). Post-partum depression can easily go unrecognized and thus untreated because new mothers are often so sleep-deprived and so unsure of themselves that they may have a hard time differentiating what is normal from what is not. On the other hand, some mothers with post-partum depression may know with certainty that something isn’t right, yet they may feel too ashamed to seek help.

Help can come in many forms but almost always includes some kind of support, whether it is professional or family and friends. Professional help can include treatment with or without medication, psychotherapy, and group therapy among others. Many medications can be safely taken while nursing.

The symptoms of PPD include some or all of the following:
· Depressed or sad mood
· Tearfulness
· Loss of interest in usual activities
· Feelings of guilt
· Feelings of worthlessness or incompetence
· Fatigue
· Sleep disturbance
· Change in appetite
· Poor concentration
· Suicidal thoughts

Post-partum anxiety is fairly common as well and, again, may be difficult to distinguish from normal feelings that accompany having a new baby. Post-partum anxiety may take the form of generalized anxiety, panic attacks, or even obsessive-compulsive disorder. Like post-partum depression, it may be possible to treat these disorders with or without medications, depending on the severity.

Post-partum psychosis is the most severe type of post-partum mood alteration and constitutes a psychiatric emergency. Symptoms include agitation, irritability, insomnia, rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganized behavior. Delusional beliefs are common in this disorder and often center on the infant. Auditory hallucinations may also occur.

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Attention Deficit/Hyperactivity Disorder

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Eating Disorders
Anorexia, bulimia, binge disorder, and other eating disorders.

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Substance Abuse
Substance abuse commonly occurs in conjunction with another psychiatric disorder. The substance abuse is often an attempt to self-medicate, and with proper treatment of the primary disorder, substance abuse is frequently much easier to treat.

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Personality Disorders
A personality disorder is defined as an enduring pattern of inner experience and behavior that deviates from what is expected within the culture. Areas that may be affected include cognition, emotional response, interpersonal relationships, and impulse control. The pattern is generally inflexible and can be traced as far back as early adulthood or even adolescence. While most personalities have at least some features of the various personality disorders, and few personalities can be neatly classified into one of these disorders, the classifications can be helpful for treatment and prognosis.
Some of the more common personality disorders are listed here:
Narcissistic Personality Disorder
Histrionic Personality Disorder
Antisocial Personality Disorder
Paranoid Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
Borderline Personality Disorder

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Borderline Personality Disorder:
Borderline personality disorder is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work, long-term planning, and the individual's sense of identity. People with borderline personality disorder suffer from a disorder of emotion regulation. It affects 2 percent of adults, mostly young women. There is a high rate of self-injury without suicide intent (including cutting, burning, drug use), as well as a significant rate of suicide attempts and completed suicide in severe cases. With help, many improve over time and are eventually able to lead productive and rewarding lives.
Symptoms include at least 5 of the following:
· efforts to avoid real or imagined abandonment
· pattern of unstable or intense relationships characterized by alternations between extremes of idealization and devaluation
· identity disturbance; unstable self-image or sense of self
· impulsivity in at least two areas that are potentially self-damaging (including sex, spending, substance abuse, reckless driving, binge eating)
· recurrent suicidal behavior or threats or self-mutilating behavior
· mood instability
· chronic feelings of emptiness
· inappropriate, intense anger or difficulty controlling anger
· temporary stress-related paranoia or dissociation

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