Anxiety Disorders

The Anxiety and OCD Treatment Center specializes in evidence-based therapy for anxiety and related disorders, including:

Obsessive Compulsive Disorder Generalized Anxiety Disorder Health Related Anxiety

Post-Traumatic Stress Disorder Panic Disorder/Agoraphobia Social Anxiety

Specific Phobia Separation Anxiety Body Dysmorphic Disorder

Body-Focused Repetitive Behaviors Trichotillomania

Obsessive Compulsive Disorder (OCD) affects approximately 1-2.5% of the adult population and approximately 2-3% of children and adolescents. OCD occurs when intrusive thoughts or images (obsessions) produce anxiety and the person then engages in behaviors (called compulsions and/or rituals) to reduce the anxiety. Most individuals recognize that their obsessions do not make sense, but feel compelled to do their compulsions anyway in order to feel less anxious or uncomfortable. Some of the more common forms of OCD are:

fears of dirt, germs, and/or contamination and compulsive washing or cleaning
distress when surroundings lack orderliness or symmetry accompanied by arranging or ordering compulsions
fears of harm coming to self or others accompanied by compulsive checking and reassurance seeking
intrusive sexual or blasphemous thoughts accompanied by compulsions such as avoidance, confessing, reassurance seeking, or ritualistic prayer

Effective treatment of OCD involves exposure with response prevention therapy, cognitive therapy and possible pharmacotherapy. Dr. Rupertus specializes in treating both the milder and more severe forms of this disorder. You will learn to gradually face the situations and thoughts that provoke your OCD while learning how not to respond with rituals, compulsions, reassurance seeking or avoidance. You will be supported as you confront the situations that OCD makes difficult and get used to it without giving in to the OCD.

Additional information: The International Obsessive Compulsive Disorder Foundation

Generalized Anxiety Disorder (GAD) occurs in approximately 3.1% of the adult population and in 3% of children and adolescents. Individuals with GAD experience chronic worry as well as chronic symptoms of anxious arousal, including muscle aches, insomnia, headaches, stomachaches, feeling tired or mildly ill, or feeling chronically restless and irritable. GAD frequently co-occurs with other mental health disorders. Individuals often believe that their worry, though bothersome, may have some value in protecting their own safety, or the safety of others, or in maintaining high standards, school performance, or job performance. repeated reassurance seeking is frequent with those who have GAD. Conversations at times will revolve around seeking the reassuring opinions of others, but with no apparent end to the worry.

Successful treatment of GAD includes therapy techniques which help the individual to learn to tolerate uncertainty, effectively solve problems, and decrease perfectionistic tendencies. Exposure therapy and imaginal flooding helps to decrease and worry related to the future. If chronic physical arousal makes it difficult to relax, then relaxation training and mindfulness training is introduced to help restore the body’s normal resting state. Referral for medication may be necessary when depression or other disorders make it difficult to engage in treatment for worry.

Additional information: The Anxiety and Depression Association of America (ADAA)

Health Related Anxiety: Many adults suffer from fears about being seriously ill, or even terminally ill, when no symptoms of serious illness exist. They misinterpret normal bodily sensations or physical symptoms as being dangerous and life threatening. Reassurance from friends, spouses, diagnostic testing, or reassurance from health care professionals may provide temporary relief, but the fears return anyway. Those who suffer from health related anxiety may have one of several of the anxiety disorders, such as generalized anxiety disorder, panic disorder or OCD, however, the main content of their fears is hypervigilance for symptoms of serious illness and repetitive reassurance seeking in order to allay their fears. Individual with these concerns may make many unnecessary visits to the doctor. They may repeatedly undergo unnecessary medical testing and procedures. Paradoxically, some with these health related concerns may end up avoiding any contact with health care providers for fear that they receive bad news.

Treatment for health related anxiety includes cognitive therapy to learn to tolerate uncertainty about health status and physical sensations, and exposure therapy and imaginal flooding to learn to tolerate feared thoughts about death and illness. Interoceptive exposure is used to help individuals learn to stop dreading changes in physical sensations.

Staff at AOTC have specialized experience in helping individuals overcome health related anxiety so that they can learn to enjoy their good health and stop fearing bad health, disability, or terminal illness. We will also work with your health care provider to help them know how to best help you when your health fears become problematic.

Additional information: The Anxiety and Depression Association of America (ADAA)

Panic Disorder With and Without Agoraphobia occurs in approximately 3% of the adult population. Individuals with Panic Disorder experience seemingly inexplicable physical symptoms that they fear and mistakenly believe might be symptoms of illness, fainting, heart attack, insanity, impending loss of control, or impending death. The sudden onset of multiple feared physical symptoms is called a panic attack. When individuals who have panic attacks begin to avoid situations that they think might trigger panic attacks, then they are diagnosed as having agoraphobia.

Adults with agoraphobia may find that activities that prevent them from quick escape are difficult or impossible to complete. The may avoid driving in busy or expressway traffic, sitting in crowded restaurants or theatres or traveling outside their “safety zone.” Individuals with agoraphobia rely upon “safety signals” to help them live their daily life, things that they believe will keep them safe from panic. Safety signals can be things such as carrying anxiety medication, only traveling with a spouse or children, only going places with a cell phone to use to call for help, or only traveling to places that are located near a major medical center.

Treatment for panic disorder includes interoceptive exposure which involves gradual practice of inducing the physical symptoms associated with panic. Therapy may also include in vivo exposure, which is practicing the real life situations that panic makes you fear or avoid. This approach Cognitive therapy is also used to help identify and successfully challenge the faulty beliefs that promote anxiety and avoidance. AOTC staff will help you overcome your agoraphobia by practicing the real life situations that panic makes difficult. Staff will accompany you during driving, shopping, exercise, or other activities that panic makes difficult. Our goal is to ensure that you regain the lifestyle you enjoyed before panic became an unwanted part of your life.

Additional information: The Anxiety and Depression Association of America (ADAA)

Social Anxiety Disorder (Social Phobia) occurs in about 7% of the adult population. It often begins to develop in adolescence and may last for a lifetime unless treated properly with cognitive behavioral therapy and/or medications. Those who suffer from SAD experience more than just feeling "shy." Shyness is a common and manageable emotion that most individuals have experienced at some time or another. It occurs when an individual initially feels uneasy or uncomfortable in a social situation, but then easily "warms up" and is able to fully participate in the situation or activity. SAD, however, prevents the individual from fully participating in and enjoying his or her life.

Individuals with SAD fear situations where there is a potential for embarrassment or humiliation of any kind. They ultimately fear being negatively judged by others. They may blush, tremble, have panic attacks, or cry when in social situations that make them uncomfortable. SAD can result in extreme avoidance and make attending classes, interviewing for jobs, socializing with friends or colleagues, dating, leaving the home, or shopping seem like insurmountable tasks. Common long-term effects such as under-education, under-employment, or unemployment can result when intense social anxiety prevents the individual from seeking employment or other opportunities for career advancement.

Fortunately, cognitive behavioral therapy and proper medications can help those who suffer from SAD develop and maintain comfort in the social world. Cognitive therapy helps challenge and replace the socially perfectionistic beliefs and misperceived expectations that make socializing difficult. Exposure therapy and social skills practice helps you learn that social situations are benign or even fun. Assertion training helps you learn how to handle the inevitable difficult social encounters that we all face without having to dread them. Staff at AOTC have experience helping those with SAD build social confidence and skills so that socializing comfortably no longer seems to be something that only others can achieve. We will help you practice real life social situations, such as public speaking, introductions, conversations and assertions.

Additional information: The Anxiety and Depression Association of America (ADAA)

Specific Phobias occur in about 5-12% of the adult population and in 7-9% of children. These phobias tend to start in childhood and last a lifetime unless treated using exposure therapy. Specific phobias occur when a child or adult develops a sudden irrational fear of a discreet situation or thing that causes intense fear and avoidance. Only about 30% of those who have a specific phobia report having had a traumatic onset in which a frightening experience (such as being bitten by a dog) triggered the fear. For most, the fear just occurs unexpectedly.

Specific phobias can be about any situation or be associated with any object. Examples of typical phobias include fear of heights, elevators, flying, being in enclosed spaces, fear of dental procedures or needles, fear of persons wearing masks or costumes, spiders or bugs, snakes, and thunderstorms. In order to be diagnosed, the phobia has to interfere with the individual's ability to do necessary daily tasks or it must cause them to plan their life around avoiding things that trigger their fear.

Treatment of specific phobias is very successful, with exposure therapy being the recommended treatment. Exposure therapy can take place in weekly sessions, in intensive daily sessions, or in a single session. Some specific phobias can be successfully treated in a single several hours long session when the patient has the determination to overcome their fear rapidly. Gradual and prolonged practice of situations related to the phobia help you or your child to overcome the fear and phobic avoidance. Our staff will help you to practice the situations that your phobia makes difficult, whether it be driving, flying, riding elevators, or completing medical or dental procedures.

Additional information: The Anxiety and Depression Association of America (ADAA)

Separation Anxiety Disorder is normal in very young children (between 8 and 14 months old). Kids often go through a phase when they are "clingy" and afraid of unfamiliar people and places. When this fear occurs in a child over age 6 years, is excessive, and lasts longer than four weeks, the child may have separation anxiety disorder.

Separation anxiety disorder is a condition in which a child becomes fearful and nervous when away from home or separated from a loved one, usually a parent or other caregiver, to whom the child is attached. Some children also develop physical symptoms such as headaches or stomachaches at the thought of being separated. The fear of separation causes great distress to the child and may interfere with the child's normal activities, such as going to school or playing with other children.

The following are some of the most common symptoms of separation anxiety disorder:

an unrealistic and lasting worry that something bad will happen to the parent or caregiver if the child leaves
an unrealistic and lasting worry that something bad will happen to the child if he or she leaves the caregiver
refusal to go to school in order to stay with the caregiver
refusal to go to sleep without the caregiver being nearby or to sleep away from home
fear of being alone
nightmares about being separated
bed wetting
complaints of physical symptoms, such as headaches and stomachaches, on school days
repeated temper tantrums or pleading

Body Dysmorphic Disorder (BDD) occurs in approximately 1-2% of the general adult population. It is a disorder in perception about appearance that causes the sufferer to anxiously focus upon monitoring and hiding the aspect of their appearance that they view as being terrible and ugly. It is not a disorder of vanity, in which a person takes great pleasure in focusing upon their appearance. It is a disorder of agonizing shame and despair about appearance.

Those who have BDD focus upon a particular feature or minor imperfection in their appearance and believe this aspect is severely disfiguring and distracting to others. They feel convinced that their imagined ugliness is obvious to others despite having gotten reassurance to the contrary from family or friends. Shame and disgust about their misperceived ugliness can cause them to avoid social interactions and to engage in elaborate attempts and great expense to disguise or conceal the aspect of their appearance that they believe to be so bothersome. Frequently those who suffer seek unnecessary plastic surgery or cosmetic treatments, even when physicians recommend against it. No amount of reassurance from others can dispel the sufferer’s belief that they are terribly disfigured.

Treatment for BDD consists of cognitive behavioral therapy and medications. Cognitive therapy helps the individual learn to recognize that the disorder is one of misperception and misplaced focus upon particular aspects of their appearance. They are taught how to gradually decrease efforts to examine and camouflage or hide their appearance. Exposure therapy helps the individual gradually resume normal activities that they avoided due to fear of having their misperceived defect become noticeable. Individuals who desire plastic surgery are strongly discouraged from getting permanent alterations to their appearance. Research has shown that individuals with BDD are inevitably disappointed with the results because their disorder is not due to a distortion in actual appearance but rather it is due to a distortion in perception about their appearance.

AOTC offers a compassionate step-by-step program to help those who suffer from body dysmorphic disorder learn to live their lives free of painful preoccupation with their appearance. We offer home visits to those individuals who may initially feel unable to come to our offices due to their BDD concerns.

Additional information: The Anxiety and Depression Association of America (ADAA)

Trichotillomania (TTM) refers to non-cosmetic hair pulling and occurs in approximately 1.5% of males and 3.5% of females. Most people who begin hair pulling are in their early teens. Women and girls are the ones most likely to seek treatment for their hair pulling, perhaps because hair loss is viewed as being less cosmetically acceptable in females than in males. Those who suffer from hair pulling may experience intense shame and distress. They may avoid activities they fear will reveal their hair loss such as being outside on windy days, standing near people taller than themselves, dating, exercise classes, swimming, or going to hairdressers. Those who suffer from TTM often incorrectly fear that hair pulling must indicate that they are especially “sick” or “self-injurious” because they are unable to stop. However, researchers and therapists who are familiar with hair pulling know that this behavior is a "habit" that is probably caused by a genetic predisposition that accidentally becomes self-reinforcing.

Treatment of TTM involves detecting and defining the individual's profile for pulling. Since no two individuals with these conditions are alike, a customized plan of behavioral and cognitive strategies must be developed for you. These strategies are applied to gradually help you or learn to dismantle the automatic chain of events that leads to pulling or picking and to replace it with more adaptive behaviors. Techniques such as awareness training, habit reversal training, stimulus control, exposure therapy, cognitive therapy, and backward chaining may be used. The goal of treatment is to achieve either a substantial decrease in pulling, or abstinence from pulling, so that the hair puller no longer has to feel embarrassed about hair loss and concealment of hair loss.

Additional Information: The Trichotillomania Learning Center for BFRBs

Body Focused Repetitive Behaviors (BFRBs) such as compulsive skin picking, compulsive nail biting, cheek biting and nose picking are very similar to trichotillomania (TTM) in their clinical presentation and their effect on the family and the sufferer’s self-image. BFRBs often co-occur with TTM. They are understood to be similar to TTM, and the same treatment approach used for TTM is used for BFRBs as well.

Treatment of BFRBs involves detecting and defining the individual's profile for the unwanted behavior. Since no two individuals with these conditions are alike, a customized plan of behavioral and cognitive strategies must be developed for you. These strategies are applied to gradually help you or learn to dismantle the automatic chain of events that leads to the unwanted behavior of pulling and to replace it with more adaptive behaviors. Techniques such as awareness training, habit reversal training, stimulus control, exposure therapy, cognitive therapy, and backward chaining may be used. The goal of treatment is to achieve either a substantial decrease or abstinence from the unwanted behavior.

Staff at AOTC have specialized experience in helping individuals learn to overcome body focused repetitive behaviors one step at a time.

Additional Information: The Trichotillomania Learning Center for BFRBs