Mental Health

Could my daughter have anorexia?

DEAR DOCTOR K: I'm worried about my 15-year-old daughter. She eats like a bird. She is very thin, but thinks she is fat. I'd like to think this is just a phase some teenagers go through, but could she have anorexia nervosa?

DEAR READER: As with most illnesses, there is not a magic dividing line between having anorexia and not. In fact, there's a big gray zone where people don't meet the criteria for a disease, yet they're not normal, either. An example is "pre-diabetes." Tens of millions of people in the United States have blood sugar levels that are not high enough to be called diabetes, but also aren't normal. It's important to recognize them, because such people have a higher risk for developing diabetes in the future.

Could I have PTSD?

DEAR DOCTOR K: Last year, a truck ran a red light, totaled my car and nearly totaled me. I spent several weeks in the hospital. Since then my body has healed, but I'm not myself. I'm very irritable, easily angered and sleeping poorly. A friend says I have PTSD, but I thought that occurred to people -- soldiers, for instance -- exposed to repeated threats.

DEAR READER: Your friend is astute. Post-traumatic stress disorder -- PTSD -- is a condition in which distressing symptoms occur after a major trauma. While the media often talk about PTSD in soldiers who have seen active combat, you don't have to be in battle to get PTSD. A single horrible event, like a bad auto accident, can surely do it.

Is online cognitive behavioral therapy effective?

DEAR DOCTOR K: I've been looking into cognitive behavioral therapy to help with my anxiety. It would be convenient to do this therapy from home and, surprisingly, there seem to be many online CBT options. But would the therapy be less effective if I didn't have a personal connection with an actual therapist?

DEAR READER: Cognitive behavioral therapy (CBT) attempts to correct ingrained patterns of negative thoughts and behaviors. It's an effective treatment for depression, anxiety and other behavioral health problems. It also is widely used to help people with chronic diseases cope with that burden.

What is body dysmorphic disorder?

DEAR DOCTOR K: The doctor says my 14-year-old daughter has something called "body dysmorphic disorder." What is it, and can it be treated?

DEAR READER: I've had questions about this condition before and have consulted with my colleague Dr. Michael Miller, assistant professor of psychiatry at Harvard Medical School.

What is cognitive restructuring?

DEAR DOCTOR K: In your column you've mentioned something called cognitive restructuring. Can you explain this in more detail?

DEAR READER: Cognitive restructuring is one part of cognitive behavioral therapy (CBT), a type of "talk therapy" that attempts to correct ingrained patterns of negative thoughts and behaviors. CBT is the leading therapy for anxiety. It is also used to treat stress, depression, eating disorders and many other problems.

What is the treatment for social phobia?

DEAR DOCTOR K: I've always thought of myself as shy. But my partner thinks I may have social phobia. Could he be right?

DEAR READER: "Social phobia" goes well beyond shyness. People with social phobia feel a constant and powerful discomfort, self-consciousness and fear of humiliation in ordinary social situations. They feel as though all eyes are turned on them. Social phobia often leads people to avoid parties and other gatherings.

Can I do anything to prevent nightmares?

DEAR DOCTOR K: Is there anything I can do to stop having terrible nightmares? They scare me, and ruin my sleep.

DEAR READER: There may be something you can do. The first thing you should know is that everyone has nightmares occasionally. That includes yours truly. Just as we don't really know why we sleep, we don't really understand nightmares. We also don't know why some people are more likely to have them.

Is dysthymia a form of depression?

DEAR DOCTOR K: My doctor says I suffer from "dysthymia." A friend says this is just a nice word for depression. What is dysthymia?

DEAR READER: Dysthymia is a type of depression. Periods of dysthymia tend to last longer than periods of depression. In fact, many people with dysthymia describe having been depressed as long as they can remember. Dysthymia typically is less severe than major depression; however, people with dysthymia are more likely to develop major depression in the future. Dysthymia is not quite as common as full-blown depression. During the course of a year, about two people out of every 100 will suffer from dysthymia. It is about twice as common in women as in men.

What is intermittent explosive disorder?

DEAR DOCTOR K: My son's doctor thinks he might have intermittent explosive disorder. I know my son has a bad temper, but I was surprised to hear that it might be a "disorder." Can you tell me more about this? What can I do to help my son?

DEAR READER: Under severe enough stress, any normally calm and collected person might become angry -- and might even be provoked to the point of violence. But some people lose their temper easily and repeatedly. In these people, tension mounts until there is an explosive release. This behavior pattern is called intermittent explosive disorder (IED).

How is OCD treated in children?

DEAR DOCTOR K: I think my 9-year-old son may have OCD. How is this condition treated in children?

DEAR READER: Before discussing treatment for OCD, it's important to describe what it is. You know, of course, but other readers may not. Children (and adults) with obsessive compulsive disorder (OCD) are troubled by repeated, intrusive, distressing thoughts (obsessions). These obsessions cause great anxiety. As a result, people with OCD often have a strong urge to repeat certain behaviors (compulsions) in order to reduce the anxiety. For example, people who have obsessive thoughts about germs may repeatedly wash their hands.