Question: I started having intense depression and anxiety out of nowhere about a week ago. About three weeks ago I was in a pretty significant car wreck where I was banged up a little, and about a month and a half ago I had a bad mushroom trip where I believed I had died. I have also done some competitive MMA fights as well, but I haven't done any in a few years, and do kratom on a regular daily basis. Any thoughts on what could help my situation?

Jim LaPierre Says...:

Hi there and thanks so much for your question.

You've certainly have had a lot going on of late

My first thought is to always get checked medically

I'd suggest seeing your Primary care physician for a consult

just to err on the side of caution.

The recent car crash was I'm sure overwhelming

Coupling what may have been a traumatic experience with the

overwhelming emotional experience of the experience you had on mushrooms

Those two events alone would leave one susceptible to a depressive episode.

I don't know your history and am mainly curious as to whether you've struggled with

feelings of depression in the past?

Either way - it feels like this is a good time to take stock and become introspective.

Do some journal writing about where your life is - what if any unmet needs exist,

what still hurts? Is your life moving in the direction you want it to? Are you living in

a way that provides fulfillment and satisfaction?

It doesn't have to be the case that something is wrong to increase your investments in you.

I hope you have loved ones who support you and who offer feedback about what they're seeing in you.

If I can answer further questions please email me: Jim@sobernow.com

Question: Hi, as a result of sever PTSD, I've tried every treatment imaginable, including TMS, Ketamine/Mushroom/MDMA and ECT therapy. Nothing has worked for over 25 years. Except alcohol. When I drink a bottle of wine I feel normal, happy, healed and at peace with the world. I am wondering, considering the severity and intractability of my mental illnesses, does being a drunk justify my decisions regarding substance abuse?

Jim LaPierre Says...:

Hi Eric,

Thank you for your question as it's one that a lot of folks struggle with.

My experience is that a lot of us seek solace and serenity in alcohol

especially when we live with PTSD.

It's only a matter of time before what helps starts to hurt

and it's a downward spiral from there.

Most of the folks I provide treatment to are in recovery from both trauma and addiction.

I hear you loud and clear that you've tried everything. I'm wondering if you have tried EMDR?

It's the most effective treatment I've seen for trauma recovery and the success rates are higher than any other form of treatment.

I'm struck by the last thing you wrote, "does being a drunk justify my decisions regarding substance abuse?"

My firend, if something is healthy, it doesn't need to be justified.

I hope you'll reach out and be open to new treatment options and to exploring what helps you to feel safe.

Alcohol is a problem waiting to happen for people like you and me.

Question: My friend is a victim of sexual assault, but does not want to report it. She does not want to go through the legal process or have everyone she knows find out. I am not very good at comforting and she does not want to go to a therapist for fear of the incident being reported. Would a therapist be required to report it?

Dr. Richard Schultz Says...:

Hello, and thank you for asking this very important question. Limited as you may feel in your ability to provide her with comfort and support, your friend is indeed fortunate to have you in her corner.

It is extremely unfortunate but quite common for individuals who have experienced sexual assault or other forms of criminal victimization to be fearful of coming forward due to concerns about any further trauma which may be triggered by doing so. We can only hope that efforts to reduce the stress of reporting such victimization will persist, and that they will be successful in reducing the cost to those who are ambivalent about telling their stories and seeking justice.

The secondary level of concern that you mention, that of mandated reporting by mental health professionals, is, I am glad to tell you, much more easily allayed. Although I do not know from where in the world you write, I will proceed based on the assumption that your friend resides in the United States (and please feel free to let me know if the facts are otherwise). In the U.S., individual statutory laws and rules vary widely in regard to mandated reporting (and also in what are known as "duty to warn/protect" laws), but the following overall guidelines are typically observed by psychiatrists, psychologists, and other licensed mental health professionals.

Mental health professional are typically permitted and/or required to report to law enforcement or other relevant agencies and parties in some or all of the following circumstances:

1.  When the licensed mental health professional has reasonable cause to believe that suspected child abuse has occurred, or is occurring;

2.  When the licensed mental health professional becomes aware that abuse, neglect and/or exploitation of a disabled adult or elder person has occurred or is occurring;

3.  When the licensed mental health professional becomes aware that a patient under their care is potentially violent and has made a clear threat of harm toward a readily identifiable intended victim; and

4.  When the licensed mental health professional becomes aware that a
patient under their care poses a significant and acute risk for self-harm.

Again, these are broad guidelines that are interpreted differently depending on individual state law, but all are observed to some degree by licensed mental health professional. In addition, the definition of what constitutes "abuse," "harm," and "significant risk" are varied and complex. However, these are the only circumstances in which a mental health professional is either compelled or permitted to violate the "doctor-patient" confidentiality attendant to the therapeutic relationship. Thus,disclosure by your friend that she has been the victim of a crime would not, in any case, be the grounds for required reporting by any mental health professional.

I hope that this response is of some use to your friend in reducing her concerns regarding confidentiality and therapy.

Finally, although you did not inquire about the appropriateness of mental health treatment for your friend, in the wake of such a traumatic event, I am going to provide you with the diagnostic criteria for Posttraumatic Stress Disorder (commonly referred to as "PTSD"). This description may assist you friend in better assessing her response to the traumatic event, as well as her need for assistance or treatment:

The diagnostic criteria for Post-Traumatic Stress Disorder are defined in
DSM-IV as follows:

1. The person experiences a traumatic event in which both of the following
   were present:
   
   1. The person experienced or witnessed or was confronted with an event
      or events that involved actual or threatened death or serious injury, or
      a threat to the physical integrity of self or others;
   2. The person's response involved intense fear, helplessness, or horror.
   
   
2. The traumatic event is persistently re-experienced in any of the following
   ways:
   
   1. Recurrent and intrusive distressing recollections of the event, including
      images, thoughts or perceptions;
   2. Recurrent distressing dreams of the event;
   3. Acting or feeling as if the traumatic event were recurring (eg reliving
      the experience, illusions, hallucinations, and dissociative flashback episodes,
      including those on wakening or when intoxicated);
   4. Intense psychological distress at exposure to internal or external cues
      that symbolize or resemble an aspect of the traumatic event;
   5. Physiological reactivity on exposure to internal or external cues that
      symbolize or resemble an aspect of the traumatic event.
   
   
3. Persistent avoidance of stimuli associated with the trauma and numbing
   of general responsiveness (not present before the trauma) as indicated by
   at least three of:


1. Efforts to avoid thoughts, feelings or conversations associated with the
   trauma;
2. Efforts to avoid activities, places or people that arouse recollections
   of this trauma;
3. Inability to recall an important aspect of the trauma;
4. Markedly diminished interest or participation in significant activities;
5. Feeling of detachment or estrangement from others;
6. Restricted range of affect (eg unable to have loving feelings);
7. Sense of a foreshortened future (eg does not expect to have a career,
   marriage, children or a normal life span).


4. Persistent symptoms of increased arousal (not present before the trauma)
   as indicated by at least two of the following:
   
   1. Difficulty falling or staying asleep;
   2. Irritability or outbursts of anger;
   3. Difficulty concentrating;
   4. Hypervigilance;
   5. Exaggerated startle response.
   
   
5. The symptoms on Criteria B, C and D last for more than one month.
6. The disturbance causes clinically significant distress or impairment in
   social, occupational or other important areas of functioning.

Sincerely,

Richard E. Schultz, Ph.D.

www.drschultz.org

Question: I have a child one month from 16, female believes she was born in the wrong body, should have been a boy. Has never been able to form friendships unless online. Always depressed diagnosed with ADHD, PTSD, very smart but exhibits some autistic symptoms soon to be tested. Genetic testing done with no abnormal findings. Trauma brain testing just dome. She was born with bi-lateral cleft pallet which is in process of being corrected but has been halted surgeries because of her emotional state until she is stabilized. The school and local mental health facility whom failed in motivating her to engage in any group or individual talk therapy and after fighting with them has agreed that residential treatment is needed. I would like to know what recommendation you may have for treatment in New England.

Jim LaPierre Says...:

Thank you for reaching out and seeking support. My experience is that PTSD often presents with many of the same symptoms and presentations of a person living with a developmental disorder like Autism. Traumatic Brain Injury seems very unlikely given what you've described. Gender Identity seems very much at the forefront and there are a myriad of challenges in treating PTSD. I am not able to recommend a specific treatment center - I'm familiar with forms of treatment but am not aware of which treatment center achieves the best results. The expert I recommend on all things relating to trauma is Michelle Rosenthal and I recommend contacting her through her site: healmyptsd.com I am happy to answer other questions or concerns as I am able. Blessed be, Jim LaPierre

Question: Exactly a week ago, I experienced a home invasion. The intruder ended up being a male living in the building and was so high/drunk that he believed he was getting into his home and instead broke into my apartment. I awoke to banging on the door, the guy had lost his keys and decided he was going to break his door to get in. When i opened the door, there was this guy stating that he owned everything in my apartment and that i should get out and then he barged his way in and started walking around. I ran for my cell phone and called 911 the whole time the guys yelling at me "this isn't your place, I don't care if you call the police I'm not going anywhere". The intruder at that point went into my bed room while i was on the phone with 911 and for what ever reason zoned out and started fussing with his cell phone. It took the police about 10-15 mins to get here and get the guy out of my room. Finally they took him away and it seems that was that. However, I've been a mess since this happened. I had to take this past week off work because of the anxiety I feel. I didn't get out of bed or shower for 3 days. And only just now having the strength to talk about it. I feel very angry and nervous. But most of all I feel embarrassed that I needed to take this amount of time to get back on my feet. Is this normal. I did go see doctor a few days after the incident and they told me to take up to a month off work. What is the appropriate amount of time to get over a home invasion anxiety?

Evan Jarschauer Says...:

Thank you for the courage to reach out after that traumatic event. Just by sharing your experience and reaching out for help, you are accelerating the healing process. Although many people experience the same symptoms of trauma after a home invasion, each person inevitably goes through their own personal journey, at their own individual pace to recover from the incident. Without question your sense of security and your personal space has been violated. Although you want things to go back to normal again, there should be no rush to recover. Take the time to work through your feelings as thoroughly as you can with a therapist.

So rather than focusing on an "appropriate amount of time to get over" the anxiety and all of the symptoms of the traumatic event at once, perhaps it might be best to work with your therapist to break the experience and subsequent symptoms down into more manageable treatment objectives or goals to achieve, ultimately getting you back to work and living your life with the greatest amount of resolved trauma possible. Unlike the veteran soldier returning home after a series of traumatic events on the battlefield, your trauma occurred right at home. However, similar to the veteran soldier experiencing symptoms of PTSD, you will be able to work through your anxiety with plenty of support and some professional counseling; you just have to give it time and stay optimistic.

Question: I dunno if you can help me. I feel beyond lost, my own family have told me that im broken, incapable of love. I am struggling with my life, ive been a victim of every kind of child abuse from my family and oldest brother. Ive tried to get help and my family have banished/abandoned me. Ive two amazing children who have kept me alive, happy but i know that i cant allow them to know how afraid i am, how lost i get. ve scared that they (my family )may be right bout me... That i am broken or incapable of love. im not in a relationship since my divorce last year, i havent had a relationship since i moved towns... Is there something wrong with me? Am i truly broken? Am i unable too love anyone?

Dr. Richard Schultz Says...:

Hello and thank you so much for reaching out to me.

We are all capable of feeling and/or believing that we are "broken," "incapable of love," "lost," "banished," and/or "abandoned."

I am sorry that you have been suffering from these feelings and beliefs.  Please know that you were not born thinking and feeling like this, and that you never chose to think or feel this way.  Please also know that you LEARNED to believe these things about yourself because of the traumatic experiences you describe experiencing as you were growing up.  We learn to treat ourselves the way we are treated.

It takes a lot of courage and enlightenment in others, especially family members, in order for them to be able to truly see, hear or accept your painful truth.  Your painful truth may scare, threaten, or sadden your family, or trigger unwanted guilt or rage in them.  Their easiest solution may therefore be to simply label you as the "broken" and bad one, in order not to have to deal with your painful truth, or consider to their own.

YOU CAN HEAL from the painful, traumatic lessons you learned and the experiences you have undergone.  You can learn to accept yourself, despite the rejection of others, and feel stronger and more lovingly toward yourself.  If you work on healing yourself, your children will benefit greatly from seeing you model courage and growth and change, and this will be a gift to them, today and ever after.  You will demonstrate for them how we as humans can best conquer the challenges presented to us in life.  To be sure, there is no life without pain or challenge or disappointment, however ongoing suffering is optional!

If you have not already done so, please seek out a qualified mental health professional to work with you in your healing process.  Yes, it is true that time heals all wounds, but it depends on what you do with the time.  You will progress in your healing with the help of external resources MUCH faster than you will without them.  Don't ever try to climb Mt. Everest in flip-flops!  Use every good tool available to assist you.

Talk with a few therapists on the phone, tell them about your struggles, and ask them how they think they might be able to help you.  They should all have specific answers to this question that make sense to you, but many of them will not.  Eliminate these people from your list of potential therapists, and then choose the one whose answer made the most sense, and who you got the best vibe from.  Go and meet with this person and see if the fit between you is a good one.  Go with your instincts, but don't expect to be unafraid.  Directly addressing what has been troubling us, but which we have had to suppress, can be painful and scary.  And it will get less so over time. 

Ideally, the therapist you choose will have a strong grounding in empirically validated treatments (this just means treatments that WORK, such as cognitive-behavioral therapy).

Read as many of the best books you can on trauma, anxiety, family dysfunction and psychological treatment for depression, anxiety and anger.  Begin with "The Feeling Good Handbook" by David Burns.  This will help you begin to see yourself more fairly and objectively, and will help you cope with and reduce painful depression, anxiety and anger.  You may also wish to read "Trauma and Recovery" by Judith Herman.  For more suggestions, visit my website (http://drschultz.org/page6.html), my Twitter feed (@mindsetdoc) and my blog (mindsetdoc.com). 

If your levels of depression, anxiety or anger are severe or acute, or if you are not functioning adequately in your life as a result of these symptoms, you may also wish to consider consulting your physician about the benefit of using psychotropic medication to help with your recovery.  Most often, these medications are prescribed by non-psychiatrists, and you can start with your PCP or OB/GYN.  It is possible that you may very much wish to NOT go this route, for a variety of reasons.  Please just make sure they are the right reasons (such as "I have already tried them extensively and they don't seem to help at all") versus reasons that have come from your family and culture (such as "only weak and crazy people need medicine," "those things will turn you into an addict," or "I can't go talking to my doctor about this stuff, it's a sick secret").  These statements all reflect great inaccuracy, harsh judgment, and toxic shame.

Remember that hiding and suppressing your truth will always make you sicker than will telling and owning the truth.  Don't practice shame-driven behavior. 

After you begin to make some progress in your recovery, carefully examine your relationships with friends, family and romantic partners.  Disengage from those with whom you must suppress your truth, those who mistreat you, those who tear you down more than they build you up.  Don't participate in bad relationship deals.  If you wouldn't want one of your children to have such a relationship, don't subject yourself to it for any reason.  Identify the healthiest, highest functioning people in your life and get closer to them.  If you don't have any, go find some!  You may find them in a recovery or 12 step group.  In the initial phase of your recovery, it will be far better for you to have NO romantic relationships than to have any more bad ones!  So don't sweat that part just yet.  It is time for you to work on and make friends with YOU. 

With regard to your children, it is of course advisable to wait until they are old enough to make some sense of what they have seen you struggle with over the years before you share the truth with them.  Your therapist can certainly provide guidance about this, but do not make the mistake of trying to shield your children from the truth out of your own fear about the possible impact on them this might cause.  They know what has been going on, even know they don't know the specifics, and even though they may have been told lies.  They will ultimately need to know the truth so that they can understand what they have observed, so that they can learn about the challenges life puts in our path and how to deal with them, so that they can learn how not to own responsibility for YOUR difficulties, and so they can be freed from the toxic secrecy that pervades dysfunctional families and other systems.  If you don't tell them the truth, you will force them to make up distorted reasons for "why mommy gets upset" and these will always have a worse impact on them than will their knowing the truth.

Finally, this plan will work if you work it and It won't if you don't. We get better at whatever we practice and we are always practicing something.

Thank you again for writing to me, I hope some of what I have written is of help to you, and please keep me posted on your progress.  That will help you, me, and other readers who are facing related challenges.

I wish you great peace and courage in traveling the healing path.

Richard E. Schultz, Ph.D.

www.mindsetdoc.com

www.drschultz.org

@mindsetdoc

404.277.8690

Question: Dear Dr. Brodsky, For the past few moments I have been plagued by uncomfortable feelings and thoughts. It started out with me fearing that I was gonna run people over with my car. I knew I wouldnt, but I would always fear that I would lost control over myself. While driving down residential streets, I sometimes drive on the wrong side of the road, if I see someone walking on the side of the street. This feeling has subsided to some extent, but it still exists. After that, I had this fear that I was gonna hurt others. That I would punch someone in the face, particularly someone smaller, and more defenseless then myself. These thoughts for the most part have left me, and I dont have to think about controlling myself or being aware of every single moment. Then I had the thought, that I might get brain damage, I read articles about brain damage which triggered this fear of getting hit in the head, I became even more cautious whenever I washed my head, I was constantly aware of how rigorously I was doing it. For one day, I had to worry about walking throught doors, making sure nothing touched my head. For a second there, I even became self aware whenever putting my headphones on, making sure my hands did not brush my temple instead of my ears. I dont feel that self aware of these actions anymore, I cant wear my headphones with easy. Then these thoughts (while still there to some extent), they started to get sexual. I got nervous when I saw some other guys at the gym. In a later incident, I started sweating profusely at the gym, and felt like I got really warm all of a sudden, and I could not concentrate on what I was doing, I was just going through the motions. At home, I guess you can say, I started to "test myself". Looked at pictures of the same sex, to see if they brought up any feelings. Even affected me when I started watching pornography, my concentration went away from the girl a lot. I guess its safe to say I am a porn addict. I watch too much, and I dont know maybe I am desensitized. I dont know if desensitization is something that leads to same sex fantasies, I am sure plenty of people watch too much pornography but it never leads them to even think about same sex fantasies. I thought that was me until a while ago. I felt like I started to get a strange feeling in my testicular region. But sometimes it was there in the presence of these fantasies. Sometimes it wasnt. Sometimes I got it when I was thinking of straight sex, and straight porn. Sometimes I even feel like I enjoy the same sex fantasies more. For 23 years of my life, I hadnt even thought about it, and now it brings up questions. Was I in denial the whole time. Did I subconsciously prevent myself from thinking these thoughts all these years. Throughout my time growing up and college, all I thought about in terms of romantic relationships and sex, was women. Now I feel like I am lost. Even when I look at a woman now, I think to myself, Am I attracted to her, or am I convincing myself that I am, just to make myself feel better. Maybe its both, I just dont know. These thoughts have made me avoid the gym sometimes, or I try to go at earlier or different times. The thoughts plague me everyday, I will even think of events in the past, that may somehow be an indicator, and then I realize it wasnt, and then I am relieved for a couple hours, until another thought pops up in my head. On some days I think there is just no way, I love women too much. But then other times I feel like I need to be honest with myself, and that maybe I am just not being honest. It even affects me when I jog around the park, I start to get these thoughts, and then I just lose the motivation to continue. I get filled with dread, shame, disgust. I feel unworthy and undeserving of anything. The only time the feeling subsides greatly is when I am in the presence of friends or close family, thats when I feel like myself. Every other time, its just me with my thoughts, trying to fight them off. I am emailing you today, because I read about you on Psychology Today. I thought maybe you would have some insight on this matter. Its all very stressful, as I am preparing for the most important exam of my life (the LSAT for law school). I wanted to put off any form of therapy until after I was done taking my exam, and was satisfied with my score, but now I dont know if I should hold off. I dont know if my sexual thoughts have any correlation to other thoughts or if thats just a personal matter of someone with an identity crisis or who has just not been honest with myself. Maybe you can help me figure out what are the potential possibilities for these thoughts. I understand expecting a consultation via email is not ideal, I am saving up money for actually therapy. I just need to express my thoughts, and get some opinion from someone who could potentially point me in the right direction. I greatly appreciate your time, and I apologize in the event that I completely wasted your time. Sincerely, Jacob email: kakabaka91@yahoo.com

Dr. Steven Brodsky Says...:

I'm sorry to hear of your plight. This advice does not constitutetreatment and I wouldn't want to diagnose someone by email. However,the symptoms you describe (reassurance seeking, repeating, testing, checking, endless internet research, etc.) are typical among the OCD sufferers I treat in my practice. OCD can take literally thousands of different forms asunique as the individual, not just the ones you read about. OCD is ananxiety condition in which the sufferer has unwanted thoughts orworries and feels compelled to get rid of the thought by either anaction, avoiding certain situations, or by mentally reassuringthemselves (or asking others to reassure them) that their worry isirrational. None of these measures works and, in fact, only make theworry worse in the long run. OCD does not mean you are going crazy, itis simply an anxiety condition and nothing more. About 6 million peoplesuffer from OCD in the U.S. alone.The good news is that OCD is very treatable, and medication might notbe needed indefinitely, if at all. Hundreds of studies support that themost effective treatment for OCD is "exposure response prevention"(ERP), which is a special type of behavior therapy designedspecifically for OCD. ERP is the only treatment endorsed by theObsessive Compulsive Foundation. ERP enables sufferers to verygradually overcome their fears and let go of their compulsions at apace with which they feel comfortable, so they are never overwhelmed.Results are achieved in a matter of months not years. ERP is moreeffective than medication, therapy and medication combined, or anyother kind of therapy. Medication provides only temporary or partialrelief and has side effects; symptoms just come back when you end themedication. ERP provides permanent relief, essentially eliminating OCDforever.Most of my clients benefit from ERP alone with no medication. Ifsomeone is on medication already, however, I recommend staying on ituntil therapy is complete and then gradually reduce and eliminatemedication while continuing the therapy for another several weeks ormonths to assure that symptoms don't return.There are about a dozen medications used for OCD. The most popular are Luvox, Zoloft, Lexepro, Celexa, Prozac, Zoloft, Effexor, and Anafranil, which is an oldermedication, and many other medications.One very helpful book on OCD is written by my former client, LindaMaran, and is called "Confronting the Bully Of OCD," which describesher therapy with me. It's a wonderful success story written from theperspective of a former OCD sufferer who overcame it. Two helpful bookswritten by professionals are "Stop Obsessing" by Edna Foa and "WhenOnce Is Not Enough" by Gail Steketee. The movie "As Good As It Gets"with Jack Nicholson is a depiction of an OCD sufferer, although aspectsof it are inaccurate.I don’t know where you live. I practice in mid-town Manhattan (34th St. 5th Ave.) and northern New Jersey (near the GWB) and would be happy to arrange an appointmentat 212-726-2390. If you live outside of the New York metropolitan area,you can find a local therapist by contacting the Obsessive CompulsiveFoundation (www.ocfoundation.org) or the Association For Behavior andCognitive Therapies (www.abct.org), or the NJ OC Foundation(www.njocf.org) or Central (Upstate) NY OC Foundation at(http://www.cnyocf.org/Providers_List.htm). Check them for an OCDspecialist in your area. Please note, by "local" and "your area" I meanwithin a 2 hour trip, so be flexible about how far you'll look; trustme it's worth the trip. If they don't have someone in your area, askthem if they know of a similar organization in your region that couldmake a referral to you. Such organizations would have words such as"OCD," "Cognitive Therapy," or "Behavior Therapy" in their titles. Forthose with limited funds, the most affordable option is some largeprestigious hospitals associated with a medical schools have clinicswith low fees that accept insurance and Medicaid/Medicare with wordssuch as "Anxiety," "Depression," "Fear and Phobia," or the above termsin it's title. Usually the therapists in these hospital clinics arejunior therapists-in-training--such as psychology graduate students ormedical students--but they are supervised by very experienced licensedprofessionals.

Finally, in the New York/New Jersey Metro area, for those with no insurance or very limited resources, I highly recommend one of the specialized treatment centers on my web site (www.ocdhotline.com/id10.html) that use the very same techniques I do, but at a fraction of the cost. I have hand picked these centers; if you were a member of my family, I wouldn't hesitate to recommend going to them.If you are considering another therapist, there are TWO "TESTQUESTIONS" you must ask them before you make an appointment: (1) Is ERPthe main technique they use? If they don't, forget about using them.And (2) How many people have they SUCCESSFULLY treated FOR OCD? Theyshould have treated at least a dozen people (a few dozen inmetropolitan areas), the people should not longer have obsessions orcompulsions or should not be taking medication any more. They shouldNOT say they just helped people "live with" their OCD better.Even better news is that OCD TREATMENT IS MORE AFFORDABLE THAN EVERBEFORE due to a new law, called Timothy's law, that went into effect in2007. Although I am out of network, as are all private specialistscompetent to treat OCD, the new law mandates all insurance companies tocover treatment for OCD (which they term a "biological condition") at ahigher rate (as much as 70%) and usually for more or unlimitedsessions. So whether or not the therapist is in-network doesn't make asbig a difference as it used to. In fact, even with HMOs, if you can'tfind and ERP specialist within network they are required to cover themout of network. For more information about insurance, fees, and financing therapy please see my web site at www.ocdhotline.com/id10.html.

If you can't find anyone in your area, I offer phonesessions for those outside of the New York Metropolitan area. It's notideal, but it's a lot better than going to someone who is not an experton OCD. I can be reached at 212-726-2390.By the way, would you mind emailing me back to tell me how you found mywebsite? Was it through a link off another website or through a keywordsearch, and, if so, which keywords and on which search engine? Yourfeedback will help me make this information more accessible to otherpeople. If you found this information helpful and would like others tobenefit from it, please consider providing a very brief rating of myservices at Health Grades (about 10 seconds)at http://tinyurl.com/GradeDr-Brodsky. Or consider providing a briefreview to Angie’s List at http://tinyurl.com/RateDrBrodsky or call in areview at 888-888-5478 (one word is sufficient).I hope this information has been helpful. I only want to ensure you getthe right kind of treatment, regardless of whether that is from me orsomeone else. May I only hear good news from you in the future!Sincerely,Dr. Brodsky

Question: I almost drowned and now with a part of my PTSD sometimes I feel like I can’t breathe even though all is OK. Once I get this feeling I have to fight to take the next breath and it feels like I can’t or I won’t be able to and I start to panic but then I do and then it repeats and during this I will by squezzing my stomach and chest muscles so hard they will hurt for hours after. I know I am supposed to try to do deep diaphramic breathing when I get like this but I can barely take tiny shallow breaths so that does not work.

Rebecca Ashton Says...:

Thank you for your question. It sounds to me like you haven't processed what happened to you. If you're not already seeing someone, I feel it could be useful to go and work through the issue with a counsellor/therapist so that you can come to terms with what happened which will in turn ease the symptoms.

In the short term, things like correcting your posture when you find it hard to breathe can help, or even try singing! We breathe differently when we sing which can help to get the blood oxygenated, as well as taking your mind off thinking about your breathing, which is what can make it seem worse and cause the panic to build up.

You say you feel panicked when this happens-another thing that could help when you start to feel anxious is a burst of star jumps, running up and down the stairs or another physical activity that suits you. This may sound counter-productive, but if you think about it, panic stems from excessive anxious energy-it's like a washing machine, going round and round with nowhere to go until it builds up to the spin cycle. A quick burst of physical activity can help to 'use up' that energy which can help to stop it turning into a panic attack.

Another method is to breathe in through your nose for the count of seven then out through your mouth for the count of eleven. This helps get the oxygen/blood flowing round the body and focusing on counting rather than on breathing can be a good distraction while you ride out the energy.

These are just a few ideas which you may or may not find useful (it's hard for me to be more specific without having met you), but I feel it is important to keep trying until you find something that works for you. A counsellor/therapist can help you to find something more tailored to you as an individual.

Good luck.

Question: My AH and I are separated, he tells me he does not love me to meet someone else, then he texes he is sorry etc then I find out he is sleeping with 3 women and has lots more on his secret phone. We were together 25 years and split for 8 months he has lost everything in 8 months me, kids our home, business his lies are out of control hardly works now is always depressed. Why all these women? when he is trying to get home to me. I am so confused by the women

Jim LaPierre Says...:

Thank you for writing. I'm so sorry to hear that your husband is in this downward spiral. Very good women often tell me that they are "confused" when in fact there's nothing confusing and everything is simply hurtful. Active alcoholics tend to be self centered and very immature emotionally. Your husband is behaving childishly and seeking lots of immediate gratification. Unfortunately, he also wants to retain you as a back up plan (alcoholics always have a back up option). Sometimes the cliches - even when they become Fcebook memes still hold true "Never make someone a priority who treats you as an option."

I'm not saying walk away permanently. I am saying walk away - at least until there is a lot of evidence that he is sober and willing to make a lot of changes. It's time to take care of you. Blessed be.

Question: How likely is it that a child with complex PTSD from some really bad traumatic abuse for the first 7 years of his life can make a full recovery (to about 90%) or so by the time he is an adult? This is regarding a fostering and adoption scenario and regarding making reasonable expectations. It wont’ change that we love him and will raise him anyway.

Dr. Ari Hahn Says...:

First off, I would like to apologize for the delay in
posting this answer. Truth be said, I actually had an answer the moment I
received the question but technical glitches and scheduling prevented by
posting the answer until now. I don't want you to think that the delay was
caused by my considering a question of less urgency. This is an a most
important question even though in some sense it is difficult to answer.

From a very important perspective your question is almost
irrelevant. You ask about the likelihood of a traumatized child of making a
full recovery. Although I do not intend to present a lecture on statistics, I
do need you to understand what's wrong with the question since that will open
up the door for a satisfying answer.

The answer of the likelihood of anybody fulfilling any other
eventuality is based on the percentage of people who fulfilled the eventuality.
In other words, if a doctor says that Joe has an 80% chance of having a heart
attack in the next year, what it actually means that if I had 100 people and I
chose one person randomly from that 100 persons I would have an 80% chance of
choosing somebody who will have a heart attack within the next year. The
percentage is really only applicable to a randomly chosen person from a large
sample of people. Once chose chosen then you might examine his genetic makeup
and find that he has a gene that protects them from heart attacks. Obviously
the likelihood of him getting a heart attack will then change.

Therefore if I were to give you a statistic that says 60% or
80% of the children who are abused on a serious and ongoing basis before the
age of seven will suffer from psychological disorders in adulthood that even if
it were a true it would say nothing about any particular singular child. The
circumstances for that particular child will be much more important in
determining the quality of a child's life than the population from which a
child was taken.

Most scientific and research evidence points to the idea
that children who have not had a significant positive care taking experience
prior to the age of seven will show particular difficulties expressing and
accepting love. The technical name for this is Reactive Attachment Disorder. If
a child has been traumatized to the point that he or she cannot trust anybody
under normal circumstances and the child might merit the label of Reactive
Attachment Disorder and the likelihood of living a normal life is extremely
diminished.

However, there is only one reparative cure for children who
have been so severely traumatized that they do not know how to receive or give
love. That is to give them an unconditional love and an unconditional support.
The more you give the child love in spite of his or her inability to reciprocate,
the greater the chances that the child will recover from the complex trauma
that defined the early years.

There will be very difficult times. Of course, there are
difficult times with all children, but with most children the parents have some
expressions of love to fall back on. You will need to gain strength from a
belief that each expression of love that you show the child, you are raising
the probability of recovery, which will be expressed when he or she knows how
to show love.