Clinical focus
Obsessive-Compulsive Disorder
OCD is a neurobiological disorder, rather than simply a form of anxiety. It is characterized by intrusive, unwanted, repetitive obsessional thoughts and/or mental imagery and resulting compulsive behaviors and avoidance. These behaviors are time-consuming and interfere significantly with life. An obsession can occur with or without 'magical thinking.' Magical thinking connects an obsessive thought to a resulting action that is not logical or even physically possible.
There are many different possible themes, or fear structures, represented in OCD. It is common for an individual to have more than one:
—Contamination OCD and Mental/Emotional Contamination OCD
—Feeling Just 'Right' (including symmetry, ordering, correcting incompleteness)
—Existential and Death OCD
—Sensorimotor/body-focused obsessions (including Hyperawareness OCD)
—Scrupulosity/Morality (including religious obsessions)
—Perfectionistic Concerns (including distress related to making mistakes)
—Relationship/ROCD
—Identity OCD (including Sexual Orientation/SO-OCD and Gender Identity OCD)
—Fear of Harm (active or passive, including catastrophic events)
—Aggressive/violent intrusive obsessions (including pOCD)
—False Memory OCD and Real Event OCD
2.2 million adults, or 1% of US population; 1 in 100 adults and 1 in 200 children in the US; roughly equal between women and men
Initial onset is bimodal, with one peak in childhood (around ages 10-12) and a second in late adolescence to early adulthood (around ages 18-25)
Distress may fluctuate (episodic) or be near-constant (acute chronic)
Genetic heredity likely plays a significant role
Exposure and Response Prevention (ERP) and Pharmacotherapy
7 out of 10 respond well to treatment, obsessional content is unrelated to treatment outcome
Social Anxiety Disorder
Social Anxiety Disorder, or Social Phobia, is an intense fear of being judged, negatively evaluated, or rejected in a social or performance situation, such as conversing with a stranger, eating in front of others, or speaking in front of a group of people. It is diagnosed when the fear or anxiety is out of proportion to the actual threat posed by the social situation.
15 million adults in the US, or 7%; somewhat more common in women than men
Median age of onset is around 13
Evidence for temperamental and genetic causal factors
Cognitive Behavioral Therapy (CBT), Exposure Therapy, and Pharmacotherapy
Post-Traumatic Stress Disorder
PTSD involves both exposure to actual or threatened death, serious injury, or sexual violence, and a resulting recurrent distress and avoidance for at least one month. Some individuals also experience dissociative symptoms, such as depersonalization or derealization. The most common trigger, rape, results in 65% of men and 46% of women developing PTSD.
7.7 million adults, or about 6.8% lifetime prevalence in the US population; an additional 5-15% experience a subclinical form of the disorder
Can occur at any age after year one
Evidence for environmental and temperamental causal factors
Prolonged Exposure (PE) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Body Dysmorphic Disorder
BDD is a complex condition involving environmental, sociocultural, and evolutionary risk factors. An individual with BDD may or may not have a physical defect that involves an excessive reaction such as intense scrutiny, compulsive and/or avoidant behavior related to the real or perceived defect. Perfectionistic beliefs may play a role in BDD thinking. In severe instances individuals may repeatedly present to dermatologic and cosmetic surgeons, or even perform self-surgeries. There is also a high likelihood of the presence of other concurrent mental disorders.
Up to 7.5 million adults or 2.4% of US adults, 1 in 50 adults; equal in males and females, although muscle dysmorphia, a specifier, is found almost exclusively in males
Subclinical symptoms often begin around ages 12-13, with the full disorder typically emerging by age 16-17; about two-thirds of adults with BDD report onset before age 18
Both environmental and genetic causal factors
Cognitive Behavioral Therapy for Body Dysmorphic Disorder (CBT-BDD) and Pharmacotherapy
OCD Related Eating Issues
There is sometimes an interesting connection between OCD and disordered eating behavior. Several studies have assessed the prevalence of obsessive-compulsive disorder among those with an eating disorder, and prevalence rates have been described as high as 40%. More specifically, females with OCD had a 16-fold increased risk of having a co-morbid diagnosis of Anorexia Nervosa, and males with OCD had a 37-fold increased risk. I have worked in unison with excellent eating disorder specialists to treat individuals presenting with this combination of clinical symptoms.
Evidence for heredity
Treatment involves simultaneous Exposure and Response Prevention (ERP) and comprehensive psychotherapy including hospitalization when necessary, Cognitive Behavioral Therapy (CBT), family therapy, and Pharmacotherapy
Executive Functioning Differences
Executive functions are the cognitive skills that allow us to plan, organize, initiate tasks, manage time, regulate emotion, and shift flexibly between demands. When these skills are inconsistent or underdeveloped relative to a person's intelligence, everyday tasks — starting a project, keeping track of belongings, managing deadlines, regulating frustration — can become disproportionately difficult. Executive functioning differences are common in ADHD, autism, anxiety, and OCD, and can also occur on their own. I help clients build sustainable systems and strategies rather than relying on willpower alone.
Executive dysfunction shows up across ADHD, autism, anxiety, and OCD, and can occur independent of any other diagnosis
Symptoms often persist from childhood into adulthood, though inattentive and organizational difficulties frequently become more noticeable — and more consequential — with adult responsibilities
Strong evidence for genetic and neurodevelopmental causal factors
Cognitive Behavioral Therapy (CBT), skills-based coaching, and structured behavioral strategies for planning, time management, and task initiation have demonstrated effectiveness
High-Masking Autism
High-masking autism describes autistic individuals who consciously or unconsciously conceal or compensate for their traits in order to meet social expectations — through scripting conversations, suppressing stimming, or forcing eye contact. Masking can make autism harder to recognize, particularly in women and those diagnosed later in life, and often comes at a real cost: chronic exhaustion, anxiety, and a fragile sense of identity. I take a strengths-based, neurodiversity-affirming approach, helping clients understand their own wiring, reduce the exhaustion of masking, and build a life that works with their brain rather than against it.
An estimated 2.2% of US adults have autism spectrum disorder; diagnosis rates are markedly lower in women, largely due to more effective masking and clinician bias toward male presentations
Many high-masking individuals are not diagnosed until adulthood, often after years of misdiagnosis with anxiety, depression, OCD, or borderline personality disorder
Strong evidence for genetic and heritable causal factors
Psychoeducation, neurodiversity-affirming therapy, sensory and communication accommodations, and treatment for co-occurring anxiety or OCD have demonstrated effectiveness
Sensory Processing Differences
Sensory processing differences involve atypical responses to sensory input — sound, light, touch, texture, movement, or internal bodily sensations — that can present as heightened sensitivity, under-responsiveness, or active sensory seeking. These differences are a core feature of autism and are also common in ADHD, and can significantly affect comfort, focus, and functioning in everyday environments like workplaces, social settings, and one's own home.
An estimated 60-90% of autistic individuals experience significant sensory processing differences; roughly half of individuals with ADHD report related sensory difficulties
Often apparent from early childhood, though many adults only connect their sensory experiences to autism or ADHD later in life
Evidence for genetic and neurodevelopmental causal factors, closely tied to underlying autism and ADHD
Occupational therapy, sensory-informed accommodations, and integration with broader autism- or ADHD-focused treatment have demonstrated effectiveness
Twice-Exceptional (2e) Support
Twice-exceptional, or "2e," describes individuals who are both intellectually or creatively gifted and have a co-occurring disability such as ADHD, autism, or a specific learning disability. The combination can be easy to miss: strengths can mask struggles, and struggles can mask strengths, often leaving both underestimated or misattributed to laziness, anxiety, or a personality trait rather than a genuine neurodevelopmental profile. I help 2e clients make sense of this dual profile, address the specific disability alongside the frustration of unmet potential, and build strategies that let their strengths carry more of the weight.
Estimated to affect 2-5% of the gifted population, though the true prevalence is difficult to establish given how frequently 2e individuals are missed or misdiagnosed
Most commonly identified in school-age children, though many are not recognized until adolescence or adulthood, after years of confusing over- and under-performance
Evidence for genetic and neurodevelopmental causal factors, tied to the underlying co-occurring condition(s)
Individualized, strengths-based therapy addressing the underlying disability, alongside skills-based coaching and accommodations that leverage giftedness rather than obscure it
Panic Disorder
Panic Disorder is diagnosed in individuals who experience panic attacks with no warning and have a preoccupying fear of additional, recurrent panic attacks for at least one month. Panic Disorder is often found with a number of comorbid conditions, most commonly agoraphobia: a fear of being in places in which escape might be difficult.
6 million adults, or 2.7% of US population; 2:1 female to male
Onset is usually in adulthood, after age 20
Evidence for genetic heredity
Highly responsive to Interoceptive Exposure Therapy, alongside Cognitive Behavioral Therapy (CBT) and Pharmacotherapy
Specific Phobias
Specific phobias are characterized by marked fear or anxiety about a specific object or situation. Some examples of common phobias are: animals, heights, needles, and flying.
19 million adults in US, or 9.1% of population, 2:1 female to male
Average age of onset is 7 years old
Evidence for temperamental, environmental, and genetic causal factors
Highly responsive to Exposure Therapy
Generalized Anxiety Disorder
GAD is characterized by persistent and excessive worry about a number of things as opposed to more specific fear themes. Individuals may be preoccupied by a wide range of issues including money, health, job, or family. The key is that they find it very difficult, or even impossible, to control their worry.
6.8 million adults, or 3.1% of the US population, 2:1 female to male
The median age for onset is 30, but the age range is very wide
Evidence for genetic, environmental, and temperamental causal factors
Pharmacotherapy and Cognitive Behavioral Therapy (CBT) have demonstrated effectiveness
Body Image Concerns
There are many people with body image issues who do not meet diagnostic criteria for Body Dysmorphic Disorder. Treatment may still be recommended if the individual's functioning is impaired due to these issues. If negative body image perception makes it more difficult to participate in day-to-day activities and pursue relationships, there are ways I can help.
Occurs more frequently, but not exclusively, in women
Cognitive Behavioral Therapy (CBT) and insight-oriented psychotherapy have been helpful
Body Focused Repetitive Behavior
BFRBs refers to any repetitive self-grooming activity that results in damage to the body. These include trichotillomania (hair pulling), dermatillomania/excoriation (skin picking), onychophagia (nail biting), lip biting, and cheek chewing. Individuals who engage in BFRBs are oftentimes unaware of the behavior in the moment and are doing it to relieve tension or stress during sedentary activities.
Up to 5% of general population, more often occurs in females
Onset typically ages 11-15
Both genetic and environmental are causal factors
Habit Reversal Training and Pharmacotherapy
Depression
There are many types of depressive disorders, each with its own data points. I will assess whether your depressive symptoms are primary, or secondary to another clinical issue.
280 million people worldwide experience depression, 1.5 to 3 times more common in females
Onset is most common in adolescence through the mid-20s, though it can appear at any age
40% heritability
Behavioral Activation, Cognitive Behavioral Therapy (CBT), interpersonal psychotherapy, and Pharmacotherapy have all demonstrated effectiveness
Attention-Deficit/Hyperactivity Disorder
ADHD is a neurodevelopmental disorder marked by persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning or development. Because its symptoms often overlap with anxiety and OCD-spectrum presentations, an accurate differential diagnosis is essential before building the right treatment plan. I frequently see ADHD presenting alongside anxiety and OCD, and treat these co-occurring conditions together.
15.5 million adults, or about 6% of the US population; the male-to-female diagnosis gap narrows substantially in adulthood, though it hasn't fully closed
Symptoms must be present before age 12, though many are not diagnosed until adulthood
Among the most heritable psychiatric conditions — twin studies estimate heritability around 70-80%
Stimulant medication, Cognitive Behavioral Therapy (CBT), and skills-based coaching have all demonstrated effectiveness
Rejection Sensitive Dysphoria
Rejection Sensitive Dysphoria (RSD) is an intense, often overwhelming emotional response to perceived criticism, rejection, or failure to meet one's own or others' expectations. It is not a standalone diagnosis but a well-recognized pattern most closely associated with ADHD, believed to stem from differences in emotional regulation and dopamine processing. RSD can drive people-pleasing, conflict avoidance, and harsh self-criticism, and often gets mistaken for a mood disorder before the underlying ADHD is identified.
Clinical observation suggests the large majority of adolescents and adults with ADHD experience some degree of RSD; 30-70% of ADHD adults report significant difficulty with emotional regulation more broadly
Believed to stem from the same dopamine-related circuitry implicated in ADHD's attentional and impulsivity symptoms
Evidence for a genetic and neurodevelopmental basis, tied closely to underlying ADHD
Cognitive Behavioral Therapy (CBT), emotion regulation skills training, and Pharmacotherapy (including stimulants and alpha-2 agonists) have shown benefit
AuDHD
AuDHD refers to the co-occurrence of Autism Spectrum Disorder and ADHD in the same individual — two conditions that were, until recently, diagnosed separately but are now understood to overlap substantially and interact in distinct ways. Someone with AuDHD may experience internal tension between autistic traits (a need for routine and predictability) and ADHD traits (impulsivity and a pull toward novelty), which can make self-understanding and standard interventions for either condition alone feel like a poor fit. I take a combined, individualized approach that addresses both profiles together rather than treating them as separate diagnoses.
An estimated 50-70% of autistic adults also meet criteria for ADHD, and roughly 45% of adults with ADHD show clinically significant autistic traits
Historically under-identified, as the DSM did not permit a dual diagnosis of autism and ADHD until 2013; many adults are only now being identified
Strong evidence for shared genetic and neurodevelopmental causal factors
Individualized, neurodiversity-affirming therapy combining ADHD-informed and autism-informed strategies, skills-based coaching, and Pharmacotherapy where appropriate
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You have honestly saved my life. I have not felt this calm in 7 years. Seeing you was the best decision I have ever made, you literally gave me my life back.
/ P.T., 36, male /