Borderline Personality Disorder (and related problems)
Borderline Personality Disorder (BPD) is a characterized by instability across 5 areas of psychological functioning: emotional dysregulation, interpersonal dysregulation, impulsive and self-destructive behaviors, dysregulation with respect to self-experience, and cognitive dysregulation. The core difficulty in BPD is regulating one’s emotions. This involves quickness to feel emotion as well as experiencing emotion to a high degree, and difficulty changing one's emotional experience and associated actions. Other features of BPD, such as suicidal and self-harm behaviors, relationship difficulties, ineffective expressions of anger, and an unstable sense of self may be viewed as either consequences of or attempts to cope with this core problem of emotion dysregulation. Importantly, even if you or your teenager have not received a diagnosis of BPD, you may benefit from participating in Dialectical Behavior Therapy (see the ‘Services’ page) if you exhibit one or more of the following features:  difficulty managing intense emotions, suicidal or self-harming behaviors, or relational turmoil.

Anxiety Disorders:

• Generalized Anxiety Disorder (Worry)
  Generalized Anxiety Disorder (GAD) is characterized by persistent and hard-to-control worry. The individual becomes entangled in anticipating negative outcomes; they often fall prey both to over-estimating the likelihood of the occurrence of a problematic event and to “catastrophizing” or over-estimating the consequences associated with the anticipated event. Topics of worry often include, but are not limited to, concerns about one’s health, the wellbeing of one’s family, work or academic performance, and finances. In addition to worry, persons with GAD experience a number of physical symptoms of anxiety, including restlessness, fatigue, muscle tension, and difficulty sleeping.

• Social Anxiety Disorder
  Social Anxiety Disorder is characterized by fear of being judged in social or performance situations. Often such persons worry that they may do something to humiliate themselves and are painfully aware of each social misstep they perceive themselves to be making. Entering the feared social setting nearly always evokes high distress, which may even include having a panic attack, even though they recognize that the intensity of their anxiety is excessive or unwarranted. Persons with heightened social anxiety frequently experience anxiety across a variety of social situations, such as at work or in the classroom, at social gatherings, or when ordering food at a restaurant. In light of the anxiety, such individuals often turn down participating in social events. Social anxiety disorder significantly impedes quality of life in that it may result in having few friends, feeling isolated and alone, reduced work or academic performance, and refraining from pursuing a romantic relationship.

• Obsessive Compulsive Disorder
  Obsessive Compulsive Disorder (OCD) is an anxiety condition characterized by unwanted, intrusive thoughts (obsessions) that cause the individual distress and that are accompanied by repetitive actions (compulsion)—often some sort of checking behavior. The repetitive behavior functions to lessen one’s discomfort, usually by providing reassurance that the intrusive worry did not or will not occur. A core feature of OCD is persistent doubt (e.g., “But was the door really locked? Maybe I didn’t turn the handle hard enough and mistakenly thought it was locked.”) and the checking behavior (e.g., returning again and again to check that the door is, in fact, locked) can be thought of as an attempt to obtain greater certainty or reassurance. Compulsive checking behaviors can be overt (e.g., checking doors, handwashing) or mental (e.g., replaying a past conversation in one’s mind again and again looking for confirmation that one didn’t do something offensive or illegal). The recommended treatment for OCD is exposure and response prevention.

• Specific Phobias
  In addition to the anxiety disorders mentioned above, individuals may suffer from intense or unwarranted fear of a specific object or situation, such as heights, bridges, enclosed spaces, a particular animal or insect, blood, or vomiting. Exposure to the feared object or situation nearly always produces high distress and may result in having a panic attack. As such, individuals often go to great lengths to avoid contact with the feared object or situation, despite significant interference with daily functioning.

Depression 
Although everyone experiences occasions of sadness, discouragement, and depressed mood, some persons experience such feelings for an extended period of time, to the point where their low mood disrupts daily functioning. For example, getting out of a bed, engaging with friends and family, staying current at work or school, and even displaying basic hygiene, like eating regular meals and bathing, can seem like insurmountable tasks. Major Depressive Disorder is characterized by experiencing depressed mood or loss of interest in activities most of the time for a duration of at least 2 weeks. Additional symptoms include feelings of worthlessness or unnecessary guilt, decreased energy, insomnia or excessive sleeping, substantial weight or appetite changes, reduced concentration, and suicidal thoughts.

Parenting Challenges
The adolescent years come with no shortage of difficult moments for parents. As a natural part of development, teenagers desire increased autonomy. They also exhibit stronger opinions about what the household rules should be. The result: the all too familiar parent-teen power struggle. Additionally, as teens spend increasing amounts of time with friends, combined with decreased parental supervision, the opportunities for engaging in risky behavior increases. However, teens often lack the sound judgment and maturity needed for their parents to feel comfortable entrusting them with increased freedom and independence. Thus, navigating adolescence can be challenging for any parent. When you add to that mix problems such as heightened emotion dysregulation and suicidal or self-harm behaviors, the task facing parents can seem unmanageable.  The integration of behavioral parent training and DBT can offer principles and strategies that empower parents to address such problems as conflict-laden (or perhaps even non-existent) communication, non-compliance, rule-breaking, aggression, dysregulated emotions, and suicidal/self-harm behaviors.

PTSD and Trauma-related Disorders
Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can develop in response to the experience of a traumatic event, such as rape, physical or sexual abuse, combat situations, violent crimes, and natural disasters. PTSD may also occur in response to intense or recurrent experiences of invalidation or emotional abuse. PTSD involves a collection of symptoms and behaviors that fall into 4 categories: (1) re-experiencing the trauma, for instance, in the form of intrusive distressing thoughts and images; (2) avoidance of trauma-related cues, such as pushing away thoughts and emotions associated with the traumatic event or avoiding situations that remind one of the event; (3) negative changes in mood or cognition, such as the inability to recall important details of the trauma, distorted beliefs of self-blame, and persistent negative emotions such as fear, guilt, and shame; and (4) heightened emotional arousal and reactivity, including hypervigilance, increased startle response, disturbed sleep, and engagement in self-destructive behaviors such as self-harm or substance abuse.