Conceptualizing Diagnosis
My clinical approach is aligned with the perspective that the diagnosis of a disorder ought to have clinical utility—specifically, to determine prognosis, treatment plans and strategies, and realistic treatment outcomes. Yet, the diagnosis of a disorder is not equivalent to a need for treatment. Need for treatment is a complex clinical decision that takes into account multiple factors. The fact that some individuals do not meet all the criteria for a disorder or show all symptoms indicative of a serious diagnosis should not be used to justify limiting their access to appropriate care.
The Conditions I Treat
Bipolar Disorders
May account for one-quarter of all completed suicides. During a manic episode, individuals do not perceive they are ill or in need of treatment. Mood may shift very rapidly.
Depressive Disorders
Many individuals report impaired ability to think, concentrate, make minor decisions and experience an unrealistic sense of worthlessness and guilt.
Anxiety Disorders
Anxiety disorders differ from one another in the type of objects or situations that induce worry, fear, panic attacks, or avoidance behavior, and the associated cognitive ideation.
Addictive Disorders
All drugs that are taken in excess and gambling and sex addiction have in common activation of the brain reward system, which is involved in the reinforcement of behaviors and production of memories.
Schizophrenia Spectrum
Disorders
Psychotic disorders are heterogeneous, and the severity of symptoms can determine degree of cognitive or neurobiological deficits. The severity of mood symptoms has prognostic value and guides treatment.
Personality Disorders
Ten distinct clinical syndromes. Frequently misdiagnosed or undiagnosed. Characteristics that define a personality disorder may not be considered problematic by the individual.
Trauma Disorders
Many exposed to a traumatic or stressful event exhibit a phenotype in which the most prominent clinical characteristics are anhedonic and dysphoric, externalizing angry and aggressive symptoms or dissociative symptoms.
Obsessive-Compulsive
Disorders
Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted. Compulsions are repetitive behaviors or mental acts performed in response to an obsession.