Clinical and Wellness Center

What We Treat

Manhattan/Westchester NY

At CBC we are committed to providing a compassionate and safe resource at our Clinical & Wellness Center, where our therapists practice leading edge, evidence-base treatments, with the goal of creating positive and enduring change for both adults and children.

Many of the common psychological problems we treat for adult, youth, and children, cover the spectrum of human emotion and behavior. Most often our clients will come to us describing a range of feelings and issues along with obstacles that they would like to move past.

We recommend you begin by meeting with one of our Therapists, who will conduct an initial evaluation to help define your needs and develop a treatment plan to help you to reach your goals.

CBC therapists can provide individual, family and group therapies and will make recommendations for our large array of unique CBT and DBT programs.

Please contact our Director of Intake Services at 212-595-9559 (ext.5) or 914-385-1150 (ext.1), or fill out the form above, with any questions regarding eligibility, for further information, or to make a referral.  If you are a current patient at CBC, please speak to your individual therapist to see how this group may be of added benefit to you.

Below we list many common problems faced by clients. These problems may co-exist. A careful diagnosis by a trained professional is necessary to understand the exact nature of the problems and how they may be best treated. Please note the list below is not comprehensive. 

Stress

Stress is the result emotion in response to a change or a threat in a situation, and is commonly experienced in many ways for various reasons. Temporary stress is common and may create little to moderate interference with a person’s life. Chronic stress, (or the response to emotional pressures over a prolonged period of time), can lead to suppress a person’s immune system and create health problems with myriad symptoms such as high blood pressure, sleep loss, headaches, chest pain, heart palpitations, stomach problems, and even skin rashes. Different variations of stress cause different reactions in your body, and cause other effects on health.

Learn More About Our Treatment Approach.

Social Anxiety Disorder/Social Phobia

Social Anxiety Disorder is the extreme fear of being judged, scrutinized, or criticized by others in social situations. Individuals fear that they will say or do something that will cause them to appear foolish in front of others or that others will notice some signs of anxiety, such as blushing, trembling or sweating. These fears lead individuals to avoid social or performance situations, such as speaking in front of others or going to social gatherings.

People who suffer from Social Anxiety Disorder tend to have little or few social, platonic, or romantic relationships, which may lead them to feel alone, powerless, or ashamed. Those with social anxiety disorder suffer greatly and find interactions in school, jobs, and relationships extremely difficult. Social anxiety disorder typical begins around the age of 13 but may begin in early childhood.

Social anxiety disorder is very common, particularly in the United States; research has found that more that one out of every eight people suffers from social anxiety disorder at some point in their lives.  Even though both shyness and social anxiety disorder may be present in many individuals, they are not the same. Shyness is a normal personality trait and should not be mistaken for social anxiety disorder

Learn More About Our Treatment Approach.

Panic Disorder With and Without Agoraphobia

Panic attacks are sudden, short, and discrete feelings of fear or dread that are accompanied by physical symptoms such as heart palpitations, sweating, shortness of breath, chest pain, nausea, feeling dizzy or lightheaded, trembling or shaking, sweating, choking sensations, nausea, abdominal distress, numbness or tingling sensations, hot flashes or cold chills, and feelings of depersonalization and derealization.

Panic Disorder is characterized by recurrent, unexpected panic attacks without reasonable cause that create great physical and psychological discomfort in individuals. Individuals with panic disorder worry about over having future attacks and suffering its consequences.  They fear that they will die, lose control or go crazy as result of these symptoms and often escape, or avoid situations that they believe will cause them to have panic attacks or use unhelpful coping behaviors in an attempt to create a sense of safety. Typically, panic disorder first occurs in early adulthood and is twice as common in women. Six million American adults experience panic disorder in a given year.

Continuous anxiety over the occurrence of panic attacks can often lead to the development of agoraphobia.  Agoraphobia is the fear or avoidance of situations in which help may not be available or escape is difficult in the case of a panic attack.  Common agoraphobic situations include shopping malls, bridges, elevators, and begin home alone.  

Learn More About Our Treatment Approach.

Obsessive-Compulsive Disorder

Often calling the doubting disease, Obsessive-Compulsive Disorder, or OCD, is typically characterized by the presence of obsessions and compulsions that the individual finds difficult to control. Obsessions are characterized as unwanted and intrusive thoughts, urges, images or impulses the person is unable to remove from their mind.

Common obsessions include a need for cleanliness, concerns over germs, fear of doing something blasphemous or causing harm to others, a need for symmetry or to do things “the right way.”  Individuals with obsessions often perform compulsive behaviors to reduce fears associated with their obsessions.  Compulsions, also known as “rituals,” are repeated actions or thought patterns that are intended to rid troublesome obsessions. Common compulsions include: excessive washing or cleaning, checking behavior (i.e.: repeatedly looking to see if the oven is turned off), repeating behaviors (i.e.: switching a light switch 15 times), mental rituals (e.g., repeating phrases or numbers), and organizing possessions in a set pattern (i.e.: color-coordinating items of clothing).

OCD occurs gradually in both adults and children/adolescents and has a chronic course. Boys most commonly develop OCD in childhood while girls typically develop OCD in early adulthood.

Learn More About Our Treatment Approach.

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder, or otherwise referred to as, GAD, is described as persistent, excessive, and unrealistic worries about everyday situations that individuals find difficult to control. Individuals with GAD constantly worry about money, health, family, work, and other issues and typically feel restless, on edge, “wound up,” irritable, and easily frustrated. They also experience muscle tension, sleep disturbance (trouble falling or staying asleep, or unsatisfying sleep), become easily fatigued, and have difficulty concentrating, often finding that their mind often “goes blank.” GAD is extremely common with women being twice as likely as compared to men to suffer from this problem.

Many individuals with GAD have other problems, such as depression, irritable bowel syndrome, or relationship difficulties.  

Learn More About Our Treatment Approach.

Post-Traumatic Stress Disorder (PTSD)

Although the bulk of individuals who experience traumatic events do not go on to develop Post-Traumatic Stress Disorder (PTSD), PTSD, may occur after individuals experience trauma or life threatening events. Common traumatic experiences include rape or sexual assault, crime victimization, physical or sexual abuse, war-related experiences, death of a loved one, natural disasters or other life threatening situations involving serious injuries, such as a car crash.

Individuals who suffer from PTSD experience three main types of symptoms.  First, they involuntarily re-experience the trauma in their minds.  This may include having nightmares and flashbacks that make it seem as if the event is recurring.  Secondly, individuals engage in avoidance behaviors.  They may avoid thinking about the memory, and avoid people, places, and things that remind them of the event. Individuals with PTSD may also have signs of physical distress, such as trouble sleeping, feeling irritable or angry, trouble concentrating, and feeling tense or on guard.  

Most people begin to experience symptoms of PTSD after a month of the trauma, while some don’t have symptoms until many years after the event.  If the symptoms arise within one month of the event and persist for less than 3 months, it is said to be acute stress disorder (ASD).  However, if the symptoms persist for more than 3 months, the diagnosis of PTSD is given. Women are twice as likely to develop symptoms of PTSD than men, and children can also fall victim to PTSD. The disorder also often occurs with other anxiety disorders, substance abuse, and depression.

Learn More About Our Treatment Approach.

Specific phobias (e.g., flying, dogs, snakes, insects, heights)

A specific phobia is defined as an extreme or irrational fear, or aversion of something. People with phobias experience high levels of distress and go out of their way to avoid the places, situations, or objects they fear. Most common phobias include fears of animals, insects, germs, heights, thunder, driving, doctors, medical procedures, flying, public transportation, and elevators. Most phobias develop in childhood but some fears such as claustrophobia can begin in adulthood.

Many people with specific phobias are aware their phobia is irrational, but are unable to overcome their fears on their own.

Learn More About Our Treatment Approach.

Separation Anxiety Disorder – Children and Adolescents

Separation anxiety is common and can be normal. Typically, it occurs in children between 18 months and three years old when a parent leaves the room or goes out of sight. Usually children can be distracted from these feelings. Separation anxiety is also normal when children are first being left at daycare or pre-school, and usually subsides after children get used to their new environment.

If child is slightly older and unable to leave parent or another family member, takes longer to calm down after parent leaves than other children, then they may have Separation Anxiety Disorder. Separation Anxiety Disorder is diagnosed when children are excessively anxious about leaving the home or if they are separated from their loved ones even for short periods of time. These children may worry that their caregivers will be harmed or injured, may be reluctant to sleep or be alone, or show other signs of distress such as nightmares or physical symptoms. Extreme homesickness and feelings of misery at not being with loved ones are common. These children may refuse to go to school, camp, or a sleepover, and demand that someone stay with them at bedtime. Separation Anxiety Disorder affects 4 percent of children. This disorder is most common in children aged seven to nine.

Learn More About Our Treatment Approach.

Selective Mutism- Children

Children and adolescents with selective mutism do not speak to most other people, even though they are comfortable speaking at home to their family and close friends. Their refusal to speak in situations where talking is expected or necessary make it difficult for them to be at school and make friends. Such children may stand motionless and expressionless, turn their heads, chew or twirl hair, avoid eye contact, or withdraw into a corner to avoid talking. Parents are sometimes surprised to learn from a teacher that their child refuses to speak at school.

Less than 1% of the population suffers from selective mutism. Children usually develop selective mutism around 5 years of age, or around the time they begin school.

Learn More About Our Treatment Approach.

School Refusal – Children

School Refusal is diagnosed when a child refuses to attend school and/or has difficulties remaining in classes during the school day. They may be completely absent from school, have fluctuating absences, or always be late for school. Twenty-eight percent of American school aged youth refuse school at some time. It is most common among children aged 10-13 years but also can peak at ages 5/6 and 14/15. It is equally common in boys and girls.

There are many reasons why children refuse school and sometimes there may be more than one reason. Younger children may avoid school because they are generally afraid of the school or afraid of specific things or objects in the school. Some adolescents may refuse school because they are afraid of being in social and/or evaluative situations at school. Some children refuse school because they want to get attention from their caregivers at home while other children may refuse school because they get tangible rewards from outside school.  

Learn More About Our Treatment Approach.

Habit Disorders

Procrastination, nose-picking, hair-pulling, overeating, nail-biting, mild substance use or overeating and other such habit disorders are linked together by the presence of repetitive and relatively stable behaviors that seem to occur beyond awareness of the person performing the behavior. Many people have some bad habits that that create little to no problems. However, these habits can become disruptive and require treatment when they occur frequently, repetitively and interfere with a person’s functioning.  

Learn More About Our Treatment Approach.

Depression

Sadness is a normal reaction to life stressors (e.g., losing a loved one, losing a job, going through  family conflict or conflicts with others). However, individuals who become depressed someone experience sadness and others symptoms on a daily basis even if there is no apparent reason for why these are sad.

People with depression experience persistent, intense sadness, feel unmotivated, or uninterested in life in general. They may have low appetite and lose weight or may overeat and gain weight. They may have difficulty falling asleep, staying asleep, or may wake up far earlier than they intend in the morning.

Conversely, individuals who become depression may oversleep, and have difficulty getting out of bed. Fatigue or low energy are also common symptoms of depression.

There are different types of depression: major depression, persistent depressive disorder, and bipolar disorder.  Depression and anxiety disorders are not the same, however, they can coexist.

Learn More About Our Treatment Approach.

Depression in Children and Adolescents

Most all children feel sad, disappointed, grouchy, or on edge at times, but children and adolescents who become depressed experience prolonged periods of low moods for days, weeks, months, or longer. The irritability and sadness becomes overwhelming and things do not seem fun anymore. Such children may show appetite changes or changes in their energy levels.

The depressed child or adolescent often complains of boredom, which gets in the way of their lives. The youth may become withdrawn, pull away from parents, and become irritable when communicating with them.

Learn More About Our Treatment Approach.

Bipolar Disorder

Bipolar Disorder is characterized by unusual shifts in a person’s mood, energy levels, and behavior. These shifts are marked by periods of mania (where a person experiences a markedly elevated, euphoric, and expansive mood that is often interrupted by occasional outbursts of intense irritability or violence) and depression (where a person experiences dramatic periods of irritability, persistent sadness, and hopelessness).  

Sometimes these moods occur together, in what is called a “mixed-state.” In-between these mood changes, people with bipolar disorder experience periods of “normal” moods.

Learn More About Our Treatment Approach.

Behavior Management Problems (Disruptive Behavior Disorders)

Several conditions create disruptions in the lives of others, such as Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder, and Conduct Disorder.

Behavior Management Problems are characterized by the presence of disrespectful, defiant, or aggressive  behaviors. Such individuals may experience difficulty following rules or instructions delivered by authority figures.

Learn More About Our Treatment Approach.

Attention Deficit Hyperactivity Disorder (ADHD)

Attention-Deficit-Hyperactivity Disorder is a condition characterized by inattention, hyperactivity, impulsiveness, or a combination of these. Individuals with ADHD are restless, have a difficult time focusing, and tend to be disorganized. Adults who have this disorder have difficulty organizing things, listening to instructions, remembering details, and completing tasks. These symptoms can affect an individual’s relationships at home, school, or work. Every case of ADHD is different, and symptoms may be presented in different levels or severity depending of the individual’s case.

Learn More About Our Treatment Approach.

Oppositional Defiant Disorder

Individuals who have difficulty getting along with others, present with anger problems, irritability, display argumentative/defiant behavior, or vindictiveness suffer from oppositional defiant disorder. This disorder poses challenges for individuals and caregivers, families, and friends. Such individuals may be touchy, and frequently become angry, resentful, and lose their temper. They may argue with, defy or refuse to comply with requests from authority figures, deliberately annoy others and blame others for their mistakes or misbehavior.

Learn More About Our Treatment Approach.

Conduct Disorder

Conduct disorder is a condition in which an individual displays an ongoing pattern of uncooperative, rebellious, and aggressive behavior toward people in authority. Such individuals often bully, threaten, or intimidate others. They are often physically cruel to others, initiate physical fights, and may use weapons to cause physical harm to others. Such individuals engage in criminal behaviors such as stealing, forcing others into sexual activity, destroying property, and setting fires.

Children and adolescents with conduct disorder often break rules and stay out at night, run away from home, and may be truant from school. This disorder can wreak havoc on the individual’s family and school, as well as the larger community.

Learn More About Our Treatment Approach.

Borderline Personality Disorder

Clients with BPD generally experience emotional dysregulation and instability, as characterized by high emotional sensitivity, reactivity, and a slow return to one’s emotional baseline.  

Individuals with BPD often have difficulties with episodic anxiety and depression as well as problems with shame, anger and anger expression.  

Second, individuals with BPD have patterns of behavioral dysregulation typically seen as impulsive behaviors. Suicidal and non-suicidal self-injurious behaviors (e.g., self-cutting) are relatively common.  Drug and alcohol use, disordered eating behavior, risky sexual behaviors, are also common and are often behavioral attempts to regulate emotions.

Third, individuals with BPD often have interpersonal difficulties.  Their relationships may be intense, chaotic, and some BPD individuals report feeling easily abandoned and lonely.

Fourth, dysregulation of one’s sense of self is reported by individuals with BPD in that they feel confused about “who they are,” “what they feel,” and “what their goals are.”  

Fifth, cognitive dysregulation often exists when individuals with BPD are emotionally dysregulated. Extreme (e.g., all or nothing) thinking, sometimes paranoid ideation or dissociation can occur and this is called cognitive dysregulation.  

There is considerable clinical heterogeneity in this diagnosis so individuals with BPD can present quite differently from one another.

Learn More About Our Treatment Approach.

Borderline Personality Disorder in Adolescents

For many years BPD was considered controversial among persons below the age of 18 since personalities were “still forming” during adolescence.  Over the past 15 years, however, it has become evident through clinical and epidemiological research that BPD does in fact exist before one’s 18th birthday.  

The research is very clear now that youth can in fact show signs and symptoms of BPD that appear similar if not the same as it does in adulthood (see BPD above). Unfortunately, many child and adolescent-trained clinicians have not been well-trained to diagnose personality disorders and instead may apply another diagnosis which may result in the youth receiving the incorrect or insufficient treatment.  

The clinicians at CBC are well-trained and capable of making the diagnosis where appropriate.

Learn More About Our Treatment Approach.

Suicidal/ Non-Suicidal Self Injurious Behaviors

Suicidal ideation and attempts are thoughts and behaviors with intent to die. Non-Suicidal Self-Injurious Behavior (NSSI) is the deliberate, self-inflicted destruction of body tissue resulting in immediate damage without suicidal intent, and the purpose is not culturally sanctioned.

These behaviors are not uncommon among adults and surprisingly common among adolescents and even pre-adolescents.  NSSI can include a variety of acts but are most commonly displayed by intentional carving or cutting of the skin, scratching, burning oneself, banging or punching objects or oneself with intention of hurting oneself, or embedding objects under the skin.

The appearance of NSSI can be concerning and frightening, so it is important to asses the “why” (i.e., the function) that is causing someone to self-injure.

Learn More About Our Treatment Approach.

Clinical and Wellness Center

What We Treat
Manhattan/Westchester NY

At CBC we are committed to providing a compassionate and safe resource at our Clinical & Wellness Center, where our therapists practice leading edge, evidence-base treatments, with the goal of creating positive and enduring change for both adults and children.

Many of the common psychological problems we treat for adult, youth, and children, cover the spectrum of human emotion and behavior. Most often our clients will come to us describing a range of feelings and issues along with obstacles that they would like to move past.

We recommend you begin by meeting with one of our Therapists, who will conduct an initial evaluation to help define your needs and develop a treatment plan to help you to reach your goals.

CBC therapists can provide individual, family and group therapies and will make recommendations for our large array of unique CBT and DBT programs.

Below we list many of common issues that our clients seek treatment for. It is not a comprehensive list and can not take the place of speaking with a professional. In many cases issues can be recognized in more than one definition. 

Stress

Stress is the result emotion in response to a change or a threat in a situation, and is commonly experienced in many ways for various reasons. Temporary stress is common and may create little to moderate interference with a person’s life. Chronic stress, (or the response to emotional pressures over a prolonged period of time), can lead to suppress a person’s immune system and create health problems with myriad symptoms such as high blood pressure, sleep loss, headaches, chest pain, heart palpitations, stomach problems, and even skin rashes. Different variations of stress cause different reactions in your body, and cause other effects on health.

 

Social Anxiety Disorder/Social Phobia

Social Anxiety Disorder is the extreme fear of being judged, scrutinized, or criticized by others in social situations. Individuals fear that they will say or do something that will cause them to appear foolish in front of others or that others will notice some signs of anxiety, such as blushing, trembling or sweating. These fears lead individuals to avoid social or performance situations, such as speaking in front of others or going to social gatherings.

People who suffer from Social Anxiety Disorder tend to have little or few social, platonic, or romantic relationships, which may lead them to feel alone, powerless, or ashamed. Those with social anxiety disorder suffer greatly and find interactions in school, jobs, and relationships extremely difficult. Social anxiety disorder typical begins around the age of 13 but may begin in early childhood.

Social anxiety disorder is very common, particularly in the United States; research has found that more that one out of every eight people suffers from social anxiety disorder at some point in their lives.  Even though both shyness and social anxiety disorder may be present in many individuals, they are not the same. Shyness is a normal personality trait and should not be mistaken for social anxiety disorder

 

Obsessive-Compulsive Disorder

Often calling the doubting disease, Obsessive-Compulsive Disorder, or OCD, is typically characterized by the presence of obsessions and compulsions that the individual finds difficult to control. Obsessions are characterized as unwanted and intrusive thoughts, urges, images or impulses the person is unable to remove from their mind.

Common obsessions include a need for cleanliness, concerns over germs, fear of doing something blasphemous or causing harm to others, a need for symmetry or to do things “the right way.”  Individuals with obsessions often perform compulsive behaviors to reduce fears associated with their obsessions.  Compulsions, also known as “rituals,” are repeated actions or thought patterns that are intended to rid troublesome obsessions. Common compulsions include: excessive washing or cleaning, checking behavior (i.e.: repeatedly looking to see if the oven is turned off), repeating behaviors (i.e.: switching a light switch 15 times), mental rituals (e.g., repeating phrases or numbers), and organizing possessions in a set pattern (i.e.: color-coordinating items of clothing).

OCD occurs gradually in both adults and children/adolescents and has a chronic course. Boys most commonly develop OCD in childhood while girls typically develop OCD in early adulthood.

 

Panic Disorder With and Without Agoraphobia

Panic attacks are sudden, short, and discrete feelings of fear or dread that are accompanied by physical symptoms such as heart palpitations, sweating, shortness of breath, chest pain, nausea, feeling dizzy or lightheaded, trembling or shaking, sweating, choking sensations, nausea, abdominal distress, numbness or tingling sensations, hot flashes or cold chills, and feelings of depersonalization and derealization.

Panic Disorder is characterized by recurrent, unexpected panic attacks without reasonable cause that create great physical and psychological discomfort in individuals. Individuals with panic disorder worry about over having future attacks and suffering its consequences.  They fear that they will die, lose control or go crazy as result of these symptoms and often escape, or avoid situations that they believe will cause them to have panic attacks or use unhelpful coping behaviors in an attempt to create a sense of safety. Typically, panic disorder first occurs in early adulthood and is twice as common in women. Six million American adults experience panic disorder in a given year.

Continuous anxiety over the occurrence of panic attacks can often lead to the development of agoraphobia.  Agoraphobia is the fear or avoidance of situations in which help may not be available or escape is difficult in the case of a panic attack.  Common agoraphobic situations include shopping malls, bridges, elevators, and begin home alone.  

 

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder, or otherwise referred to as, GAD, is described as persistent, excessive, and unrealistic worries about everyday situations that individuals find difficult to control. Individuals with GAD constantly worry about money, health, family, work, and other issues and typically feel restless, on edge, “wound up,” irritable, and easily frustrated. They also experience muscle tension, sleep disturbance (trouble falling or staying asleep, or unsatisfying sleep), become easily fatigued, and have difficulty concentrating, often finding that their mind often “goes blank.” GAD is extremely common with women being twice as likely as compared to men to suffer from this problem.

Many individuals with GAD have other problems, such as depression, irritable bowel syndrome, or relationship difficulties.  

 

Post-Traumatic Stress Disorder (PTSD)

Although the bulk of individuals who experience traumatic events do not go on to develop Post-Traumatic Stress Disorder (PTSD), PTSD, may occur after individuals experience trauma or life threatening events. Common traumatic experiences include rape or sexual assault, crime victimization, physical or sexual abuse, war-related experiences, death of a loved one, natural disasters or other life threatening situations involving serious injuries, such as a car crash.

Individuals who suffer from PTSD experience three main types of symptoms.  First, they involuntarily re-experience the trauma in their minds.  This may include having nightmares and flashbacks that make it seem as if the event is recurring.  Secondly, individuals engage in avoidance behaviors.  They may avoid thinking about the memory, and avoid people, places, and things that remind them of the event. Individuals with PTSD may also have signs of physical distress, such as trouble sleeping, feeling irritable or angry, trouble concentrating, and feeling tense or on guard.  

Most people begin to experience symptoms of PTSD after a month of the trauma, while some don’t have symptoms until many years after the event.  If the symptoms arise within one month of the event and persist for less than 3 months, it is said to be acute stress disorder (ASD).  However, if the symptoms persist for more than 3 months, the diagnosis of PTSD is given. Women are twice as likely to develop symptoms of PTSD than men, and children can also fall victim to PTSD. The disorder also often occurs with other anxiety disorders, substance abuse, and depression.

 

Specific phobias (e.g., flying, dogs, snakes, insects, heights)

A specific phobia is defined as an extreme or irrational fear, or aversion of something. People with phobias experience high levels of distress and go out of their way to avoid the places, situations, or objects they fear. Most common phobias include fears of animals, insects, germs, heights, thunder, driving, doctors, medical procedures, flying, public transportation, and elevators. Most phobias develop in childhood but some fears such as claustrophobia can begin in adulthood.

Many people with specific phobias are aware their phobia is irrational, but are unable to overcome their fears on their own.

 

Separation Anxiety Disorder – Children and Adolescents

Separation anxiety is common and can be normal. Typically, it occurs in children between 18 months and three years old when a parent leaves the room or goes out of sight. Usually children can be distracted from these feelings. Separation anxiety is also normal when children are first being left at daycare or pre-school, and usually subsides after children get used to their new environment.

If child is slightly older and unable to leave parent or another family member, takes longer to calm down after parent leaves than other children, then they may have Separation Anxiety Disorder. Separation Anxiety Disorder is diagnosed when children are excessively anxious about leaving the home or if they are separated from their loved ones even for short periods of time. These children may worry that their caregivers will be harmed or injured, may be reluctant to sleep or be alone, or show other signs of distress such as nightmares or physical symptoms. Extreme homesickness and feelings of misery at not being with loved ones are common. These children may refuse to go to school, camp, or a sleepover, and demand that someone stay with them at bedtime. Separation Anxiety Disorder affects 4 percent of children. This disorder is most common in children aged seven to nine.

 

Selective Mutism- Children

Children and adolescents with selective mutism do not speak to most other people, even though they are comfortable speaking at home to their family and close friends. Their refusal to speak in situations where talking is expected or necessary make it difficult for them to be at school and make friends. Such children may stand motionless and expressionless, turn their heads, chew or twirl hair, avoid eye contact, or withdraw into a corner to avoid talking. Parents are sometimes surprised to learn from a teacher that their child refuses to speak at school.

Less than 1% of the population suffers from selective mutism. Children usually develop selective mutism around 5 years of age, or around the time they begin school.

 

School Refusal – Children

School Refusal is diagnosed when a child refuses to attend school and/or has difficulties remaining in classes during the school day. They may be completely absent from school, have fluctuating absences, or always be late for school. Twenty-eight percent of American school aged youth refuse school at some time. It is most common among children aged 10-13 years but also can peak at ages 5/6 and 14/15. It is equally common in boys and girls.

There are many reasons why children refuse school and sometimes there may be more than one reason. Younger children may avoid school because they are generally afraid of the school or afraid of specific things or objects in the school. Some adolescents may refuse school because they are afraid of being in social and/or evaluative situations at school. Some children refuse school because they want to get attention from their caregivers at home while other children may refuse school because they get tangible rewards from outside school.  

 

Habit Disorders

Procrastination, nose-picking, hair-pulling, overeating, nail-biting, mild substance use or overeating and other such habit disorders are linked together by the presence of repetitive and relatively stable behaviors that seem to occur beyond awareness of the person performing the behavior. Many people have some bad habits that that create little to no problems. However, these habits can become disruptive and require treatment when they occur frequently, repetitively and interfere with a person’s functioning.  

 

Behavior Management Problems (Disruptive Behavior Disorders)

Several conditions create disruptions in the lives of others, such as Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder, and Conduct Disorder.

Behavior Management Problems are characterized by the presence of disrespectful, defiant, or aggressive  behaviors. Such individuals may experience difficulty following rules or instructions delivered by authority figures.

 

Attention Deficit Hyperactivity Disorder (ADHD)

Attention-Deficit-Hyperactivity Disorder is a condition characterized by inattention, hyperactivity, impulsiveness, or a combination of these. Individuals with ADHD are restless, have a difficult time focusing, and tend to be disorganized. Adults who have this disorder have difficulty organizing things, listening to instructions, remembering details, and completing tasks. These symptoms can affect an individual’s relationships at home, school, or work. Every case of ADHD is different, and symptoms may be presented in different levels or severity depending of the individual’s case.

 

Oppositional Defiant Disorder

Individuals who have difficulty getting along with others, present with anger problems, irritability, display argumentative/defiant behavior, or vindictiveness suffer from oppositional defiant disorder. This disorder poses challenges for individuals and caregivers, families, and friends. Such individuals may be touchy, and frequently become angry, resentful, and lose their temper. They may argue with, defy or refuse to comply with requests from authority figures, deliberately annoy others and blame others for their mistakes or misbehavior.

 

Attention Deficit Hyperactivity Disorder (ADHD)

Attention-Deficit-Hyperactivity Disorder is a condition characterized by inattention, hyperactivity, impulsiveness, or a combination of these. Individuals with ADHD are restless, have a difficult time focusing, and tend to be disorganized. Adults who have this disorder have difficulty organizing things, listening to instructions, remembering details, and completing tasks. These symptoms can affect an individual’s relationships at home, school, or work. Every case of ADHD is different, and symptoms may be presented in different levels or severity depending of the individual’s case.

 

Conduct Disorder

Conduct disorder is a condition in which an individual displays an ongoing pattern of uncooperative, rebellious, and aggressive behavior toward people in authority. Such individuals often bully, threaten, or intimidate others. They are often physically cruel to others, initiate physical fights, and may use weapons to cause physical harm to others. Such individuals engage in criminal behaviors such as stealing, forcing others into sexual activity, destroying property, and setting fires.

Children and adolescents with conduct disorder often break rules and stay out at night, run away from home, and may be truant from school. This disorder can wreak havoc on the individual’s family and school, as well as the larger community.

 

Depression

Sadness is a normal reaction to life stressors (e.g., losing a loved one, losing a job, going through  family conflict or conflicts with others). However, individuals who become depressed someone experience sadness and others symptoms on a daily basis even if there is no apparent reason for why these are sad.

People with depression experience persistent, intense sadness, feel unmotivated, or uninterested in life in general. They may have low appetite and lose weight or may overeat and gain weight. They may have difficulty falling asleep, staying asleep, or may wake up far earlier than they intend in the morning.

Conversely, individuals who become depression may oversleep, and have difficulty getting out of bed. Fatigue or low energy are also common symptoms of depression.

There are different types of depression: major depression, persistent depressive disorder, and bipolar disorder.  Depression and anxiety disorders are not the same, however, they can coexist.

 

Depression in Children and Adolescents

Most all children feel sad, disappointed, grouchy, or on edge at times, but children and adolescents who become depressed experience prolonged periods of low moods for days, weeks, months, or longer. The irritability and sadness becomes overwhelming and things do not seem fun anymore. Such children may show appetite changes or changes in their energy levels.

The depressed child or adolescent often complains of boredom, which gets in the way of their lives. The youth may become withdrawn, pull away from parents, and become irritable when communicating with them.

 

Bipolar Disorder

Bipolar Disorder is characterized by unusual shifts in a person’s mood, energy levels, and behavior. These shifts are marked by periods of mania (where a person experiences a markedly elevated, euphoric, and expansive mood that is often interrupted by occasional outbursts of intense irritability or violence) and depression (where a person experiences dramatic periods of irritability, persistent sadness, and hopelessness).  

Sometimes these moods occur together, in what is called a “mixed-state.” In-between these mood changes, people with bipolar disorder experience periods of “normal” moods.

 

Borderline Personality Disorder

Clients with BPD generally experience emotional dysregulation and instability, as characterized by high emotional sensitivity, reactivity, and a slow return to one’s emotional baseline.  

Individuals with BPD often have difficulties with episodic anxiety and depression as well as problems with shame, anger and anger expression.  

Second, individuals with BPD have patterns of behavioral dysregulation typically seen as impulsive behaviors. Suicidal and non-suicidal self-injurious behaviors (e.g., self-cutting) are relatively common.  Drug and alcohol use, disordered eating behavior, risky sexual behaviors, are also common and are often behavioral attempts to regulate emotions.

Third, individuals with BPD often have interpersonal difficulties.  Their relationships may be intense, chaotic, and some BPD individuals report feeling easily abandoned and lonely.

Fourth, dysregulation of one’s sense of self is reported by individuals with BPD in that they feel confused about “who they are,” “what they feel,” and “what their goals are.”  

Fifth, cognitive dysregulation often exists when individuals with BPD are emotionally dysregulated. Extreme (e.g., all or nothing) thinking, sometimes paranoid ideation or dissociation can occur and this is called cognitive dysregulation.  

There is considerable clinical heterogeneity in this diagnosis so individuals with BPD can present quite differently from one another.

 

Suicidal/ Non-Suicidal Self Injurious Behaviors

Suicidal ideation and attempts are thoughts and behaviors with intent to die. Non-Suicidal Self-Injurious Behavior (NSSI) is the deliberate, self-inflicted destruction of body tissue resulting in immediate damage without suicidal intent, and the purpose is not culturally sanctioned.

These behaviors are not uncommon among adults and surprisingly common among adolescents and even pre-adolescents.  NSSI can include a variety of acts but are most commonly displayed by intentional carving or cutting of the skin, scratching, burning oneself, banging or punching objects or oneself with intention of hurting oneself, or embedding objects under the skin.

The appearance of NSSI can be concerning and frightening, so it is important to asses the “why” (i.e., the function) that is causing someone to self-injure.

 

Borderline Personality Disorder in Adolescents

For many years BPD was considered controversial among persons below the age of 18 since personalities were “still forming” during adolescence.  Over the past 15 years, however, it has become evident through clinical and epidemiological research that BPD does in fact exist before one’s 18th birthday.  

The research is very clear now that youth can in fact show signs and symptoms of BPD that appear similar if not the same as it does in adulthood (see BPD above). Unfortunately, many child and adolescent-trained clinicians have not been well-trained to diagnose personality disorders and instead may apply another diagnosis which may result in the youth receiving the incorrect or insufficient treatment.  

The clinicians at CBC are well-trained and capable of making the diagnosis where appropriate.

 

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