These are common symptoms of many (but not all) the areas in which I specialize. Prevalence is listed to educate that these struggles are more common than you may think, and to let you know you are not alone. Do you recognize any areas (or multiple areas) in which you may be struggling? A good assessment leads to more clearly defined treatment goals, and a mental health professional can help you clarify these. How common are mental health concerns? Very common. It is estimated that from 26% to 32% of adults (that’s more than 1 out of every 4 people) are struggling with a mental health concern (prevalence for 18 and older over a 12 month period). For teens age 13 to 17, the rate is estimated to be at 40% (that’s 2 out of every 5 kids). Nearly two-thirds of people with a known mental health concern never seek help from a professional.
That’s a lot of people struggling and in emotional pain.
The OCD and Anxiety Treatment Center – Asheville, PLLC, provides comprehensive cognitive behavioral assessment and treatment for those experiencing mild to incapacitating symptoms in life. Assessment of co-existing psychological conditions is provided. Treatment goals are defined and customized to the individual and/or family in a collaborative manner. Please note that the OCD and Anxiety Treatment Center provides cognitive behavioral therapy intervention. It does not provide medication management. The educational information provided here should not substitute for a diagnostic assessment with a trained and licensed clinician.
Obsessive Compulsive Disorder
Obsessive Compulsive Disorder
Definition: OCD is characterized by obsessions and compulsions. Obsessions are unwanted thoughts, images or impulses that enter into your mind which generate anxiety, doubt, distress and discomfort. Compulsions are those behaviors (physical and/or mental rituals) that are done in an effort to try to reduce the doubt and distress. At times you may try to resist them but this can prove difficult. Anxiety and distress may persist until the ritual is completed, or a person engages in avoidance. Unfortunately, the more an individual tries to get relief and gain control of OCD by doing the rituals or engaging in avoidance, the more extensive the OCD can become.
Symptoms: While the specific content of OCD varies across individuals, certain symptoms are common in OCD. An individual may have one or more subtypes of OCD. Examples include contamination obsessions (fear of germs, disease, illness to self or others, fear of body fluids, environmental contaminants, fear of negative emotions), fear of geographical locations), obsessions regarding symmetry or exactness/perfectionism (the need to have thoughts, actions or items be just right), religious obsessions or scrupulosity (excessive concern with right and wrong, morality, sacrilege or blasphemy, thinking or doing something considered offensive to God), sexual obsessions (intrusive unwanted sexual thoughts), aggressive obsessions (fear of harm to self or others, fear of being the cause of something terrible happening), superstitious obsessions, and a variety of other obsessions not listed here. Common compulsions can include, but are not limited to, cleaning and washing compulsions (hands, bathing, household or inanimate objects, excess use of hand sanitizer or other cleaning products), checking compulsions (locks, appliances, checking that harm or something terrible did not happen to self or others), counting compulsions (perceived good numbers, odd or even numbers, lucky numbers, specific number sequences), repeating rituals (need to repeat a routine activity, praying or repetition of phrases, rereading or rewriting), as well as numerous other types of rituals. Of note, some people have what is called Tourettic OCD (TOCD). TOCD is driven more by the intensity of sensory discomfort than by intrusive obsessions, doubt or anxiety. There is a deliberateness in performing a tic-like behavior that reduces the discomfort and makes one “feel right” (versus an involuntary tic response following a premonitory sensation as seen in those diagnosed with tics or tourette syndrome). An individual with any OCD subtype can have good, fair or poor insight into their OCD dynamics. An individual can have good, fair or poor insight into their OCD dynamics.
Stats: OCD occurs in 2% to 5% of the population. Thus, it is estimated that from 1 out of every 50 people, to 1 out of every 20 people, struggle with OCD. One-third to one-half report onset in childhood. OCD is equally common across males and females. More than half of people with OCD have another diagnosis as well, which has implications for treatment direction.
Definition: Individuals experience an abrupt surge from a calm state to an anxious fearful state. Panic attacks occur multiple times and can take the form of being expected (in response to a known trigger) or unexpected (perceived as happening with no known cause). Common symptoms include: increased heart rate, feeling nauseous or having abdominal distress, shaking or trembling, feeling light-headed, dizzy or faint, feeling like you are smothering or are short of breath, chest pain or discomfort, feelings of choking, sweating, having a wave of chills or a flush of heat, numbness or tingling sensations, feelings of being disconnected with your surroundings or a feeling of unreality (derealization), feeling of being separate or somehow detached from oneself (depersonalization), ringing in the ears or vision changes, headaches, and fears of losing control, going crazy and/or fears of dying, to name a few. Frequency, intensity, and sensations experienced can differ from person to person. Worries may focus on health concerns, social concerns (e.g., embarrassment or being judged by others), fears of losing control, and/or fear of the uncomfortable experience one goes through when having a panic attack (a fear of the fear experience, or fear of the body sensations that occur with the fear). Avoidance behavior is common. Panic attacks occur mostly in the day but at least one quarter of people will report at least one night time panic attack.
Stats: The twelve month prevalence estimate for adults and teens is about 2%-3% in the general population; that’s 2-3 out of every 100 people. Female are affected more than male at about 2:1.
Compulsive Hair Pulling
Compulsive Hair Pulling (Trichotillomania); Body Focused Repetitive Behavior
Definition: Individuals experience a recurrent urge to pull out one’s hair, resulting in hair thinning and loss, despite repeated attempts to decrease or stop the pulling. Hair-pulling (a body focused repetitive behavior, or bfrb) can occur from any region of the body where hair grows, but most common pulling areas are brows, lashes and scalp. An individual may pull from just one area, or across many areas. Hair-pulling sites can vary over time. Episodes of pulling can be brief or can continue for hours. Hair-pulling can be triggered by specific body sensations (a tingly/itchy sensation), within specific situations (reading, bedtime, car, computer use), as well as when experiencing certain emotional states (boredom, anxiety). Pulling urges can start with a feeling of tension and can result in a feeling of gratification or sense of relief when the hair is pulled out. Individuals typically do not report pain when pulling. After pulling, an individual may play with the hair, examine it visually, and/or put it in their mouth and bite or chew it. Swallowing hair can result in medical concerns. Some individuals pull in a focused manner with awareness, while others pull automatically without awareness. Some report both styles of pulling. Attempts to camouflage areas of hair loss are common, as are feelings of shame, embarrassment and a feeling of loss of control. Hair loss can appear minimal or extensive. Many individuals with hair-pulling also experience skin-picking, nail-biting, or lip-chewing, (body focused repetitive behaviors).
Stats: Prevalence in adults and teens is 1%-2%, or roughly 1 out of every 50 people. Hair-pulling occurs more often in female than male in a ratio of 10 to 1. About 60% of those individuals struggling with compulsive hair-pulling are also struggling with another condition.
Definition: Persistent difficulty discarding or parting with possessions. An individual can experience intense distress (fear, guilt, anxiety, anger) at the thought of discarding items, regardless of their value, and there is an accumulation of objects and clutter. The accumulation of objects can provide a sense of joy and reward despite the interference in life and living situation. In addition to long-standing difficulties discarding items, there can be an excessive acquisition of items even though there may be no available space for these items. Individuals with hoarding difficulties can express the following reasons for inability to discard items; perceived usefulness or aesthetic value of items, a strong sentimental attachment, fear of being wasteful, thoughts that they might hurt the feelings of the person who gave the item (even years later), being responsible for the fate of a possession, fear of losing something important, to name a few. Excessively collected items can include valuable items as well as items most people would consider of little to no value. There is difficulty organizing possessions. Living areas can become unusable for the purpose for which they were designed. Useable space can become limited. Insight can be good, fair, poor or absent; there can be a denial that there is a problem despite interference in one’s own life or interference and distress experienced in the lives of family members.
Stats: Hoarding appears to be more common in older adults than young adults, although it can occur in the teen years. It is equally common in both male and female. Prevalence is 2% to 6% of the population. It is estimated that roughly 1 to 3 out of every 50 people, struggle with hoarding difficulties. Of those with hoarding, roughly 1 out of every 5 will also have OCD.
Depression is common. It can range from mild to severe in intensity. Depression causes a person to feel persistently sad, blue, and empty. Symptoms affect how you think, feel and handle daily activities. Depression can cause changes in sleep, changes in appetite, reduced interest in activities previously enjoyed, changes in energy levels, trouble with concentration, interference with memory and making decisions, and some report increased feelings of guilt. Feelings of hopelessness, helplessness, and worthlessness can be intense and unrelenting. Self-loathing is common. Self-critical and self-derogatory thoughts are present and persistent. There is pervasive unhappiness. Positive emotions and humor are difficult to experience. Many report feeling extreme fatigue. Some experience thoughts about wanting the emotional pain to end; some but not all of these will report thoughts of suicide ideation. Adults, teens and kids can experience depression. Possible causes include a combination of biological, psychological, and social factors. For children (and some adults) depression can present differently, with increased irritability, increased physical complaints, agitation and restlessness. Whatever the cause of your depression, it’s important to tell your doctor how you are feeling.
There are many forms of depression. The causes of your depression will determine treatment direction. Here are brief descriptions of some (but not all) types of depression. These are listed for educational purposes. Seek assistance from a specialist to determine the type of depression you have and the right treatment for you.
Major Depressive Disorder: For at least two weeks or longer, individuals experience a depressed mood most of the day for most days. This is a change from their prior level of functioning. There is a loss of interest or pleasure in activities, and depression levels cause significant interference in life. This category can include those individuals that have a clear seasonal pattern to their depression episodes. Stats: Depression can occur at any age. Up to 7% of individuals experience major depression (up to 1 in 15 people; 12 month prevalence). Those from 12-29 have a higher rate of depression. Major depression is more common in females by 3:1. Sadly, estimates report that more than 60% of teens, and 35% of adults with major depression do not receive treatment (NIMH, 2017).
Persistent Depressive Disorder (Dysthymia): If an individual’s mood disturbance continues long term, for at least two years for adults (one year for kids, and depression may display itself as increased irritability), then they may qualify for this diagnosis. People experience chronic sadness. and depression becomes a part of their everyday experience. These individuals will not have more than two months of relief from their depression over a two year period. Stats: About 4% of people struggle with this form of chronic depression (roughly 1 out of every 25 people).
Bipolar Disorder: There are different forms: bipolar I and bipolar II. Those struggling with bipolar disorder experience instability of mood which can result in impairment in work and social functioning. In bipolar I, a major depressive episode is common, but it is not required for a diagnosis. With bipolar I, it is necessary to meet the criteria for experiencing a manic episode. In bipolar II, individuals usually have significant amounts of time experiencing depression. For this diagnosis, an individual has to experience at least one episode of major depression in their lifetime, and at least one hypomanic episode. An accurate assessment determines treatment directions. Stats: Prevalence is about 2%, or 2 out of every 100 people for individuals 12 and older.
Postpartum (Peripartum) Depression: Onset of depression episodes can occur either during pregnancy (peripartum) or after delivery (postpartum). Mood changes are due to pregnancy neuroendocrine changes. This form of depression is often accompanied by anxiety and panic attacks. Stats: Between 3-6% of women will experience this form of depression (up to 6 out of every 100 women).
Premenstrual Dysphoric Disorder: Some women report increased mood lability just prior to the beginning of their menstrual cycle. Lability refers to a more rapid than usual mood change involving higher intensity of emotions which are experienced in a way that is greater than the person’s feelings. Mood changes can include depression but may also include irritability and/or anxiety. Changes such as insomnia or hypersomnia, difficulty concentrating, and changes in appetite, etc. are present. This experience starts just before the menstrual cycle, and ends around the onset on menses or shortly after. This is followed by a time of being symptom free prior to the next menstrual cycle. This pattern is seen over more than two cycles (via daily symptom ratings). Stats: Prevalence is estimated about 1.5 % of menstruating women (1 – 2 out of every 100).
Adjustment Disorder with depression (with or without anxiety): A depressive episode can occur in response to a psychosocial stressor. An individual may experience emotional and behavioral symptoms about three months after a major life change. The distress causes some interference in life, and the distress is more than what would typically be expected from that life event. Distress can be in the form of anxiety, or depression, or both. Examples can include: recent move, job change, family change, recent medical diagnosis, recent surgery, relationship change, medical treatment, unremitting pain, etc. Stats: Many people experience anxiety and/or depression in response to a stressor, and while the exact stats are unknown, it is estimated that between 5 to 20 percent of people struggle with higher than expected emotional levels following a major life event (up to 1 out of every 5 people). Male and female are impacted equally.
Depression due to a medical condition: A prominent and persistent period of mood dysregulation that is due to the etiology of the underlying medical condition. Examples can include stroke, Huntington’s disease, Parkinson’s disease, Cushings’s disease, multiple sclerosis, systemic lupus, traumatic brain injury, hypothyroidism, etc. It can be important to assess the biological influence of the medical condition itself versus an adjustment reaction with depression as a result of the medical condition’s contribution to life stress.
Substance/Medication induced depression: The key variable in this etiology is the causal relationship of use of medications or substances prior to the induced mood dysregulation, and/or during withdrawal. Depressive symptoms are associated with ingestion, injection, or inhalation. For example, a small percent of people may experience medication induced depression from
antiviral agents, cardiovascular medications, retinoic acid derivatives, antidepressants, anticonvulsants, anti-migraine agents, antipsychotics, hormonal agents (including corticosteroids and oral contraceptives), and immunological agents, to name a few. For a small percent of people, substance induced depression may also result from the use of amphetamine or other stimulants, sedatives, hypnotic or anxiolytics, cocaine, opioids, alcohol, inhalants, phencyclidine or other hallucinogen, to name a few.
Disruptive Mood Dysregulation Disorder: This category is for children and preteens (up to 12 years old) with chronic persistent irritability, and frequent episodes of extreme behavioral dysregulation. Temper outbursts are common. Children can express depression differently than adults. It is important to carefully distinguish this mood disorder from other conditions with a similar presentation, as this guides treatment direction.
Bereavement and Loss: Feelings of loss can be caused by the death of a loved one, losses due to a natural disaster, financial ruin, experiencing a serious medical illness or disability, etc. These events may include feelings of intense sadness, rumination about the loss, insomnia, appetite changes, which can resemble a depressive episode. Normal levels of sadness and feelings of emptiness are seen at these times. The sadness typically is experienced in waves and tends to decrease over time. Self-esteem is generally preserved. These symptoms are understandable and appropriate to loss. However, for some, as time continues, an ongoing persistent depressed mood, increased negative and pessimistic ruminations, feelings of worthlessness and difficulty experiencing pleasure, may suggest a depression diagnosis.
Compulsive Skin Picking
Compulsive Skin Picking (Excoriation Disorder)
Definition: Skin-picking, or excoriation disorder, is a recurrent picking of one’s skin, most commonly the face, arms and hands. However, skin picking can occur on any site on the body. Excessive skin picking a body focused repetitive behavior can be triggered by certain emotional states such as anxiety or boredom, can occur in response to specific situations or an environmental stimulus, and/or may be preceded by an increasing tension to pick accompanied by a sense of gratification or relief after the picking. Despite an immediate sense of relief, an overall distress (including embarrassment and shame) is reported due to picking damage. Individuals typically pick healthy skin, but picking can occur around areas of skin irregularity (such as pimples, scabs, calluses), or in response to other skin conditions. Fingers or tools (tweezers, pins for example) may be used. In addition to picking, behavior can include skin rubbing, squeezing or lancing. Time spent picking and overall skin damage can be mild to severe. Pain is not typically reported. Picking can be focused (with awareness) or automatic (without awareness).
Stats: Lifetime prevalence is roughly 1%-2% of the population, or 1 out of every 50 people. Picking is more common in female versus male by 3:1.
Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD)
Definition: An individual experiences excessive apprehension and worry about multiple every day, real-life, events and activities, with no obvious reasons for the worry. Individuals can find it difficult to control the worry. These worries are above and beyond what might be considered usual worries, take the form of catastrophizing the worst outcomes, and cause interference in daily functioning. Many report that they have felt worried or nervous their whole life. Reports of ongoing restlessness, irritability, fatigue, difficulty concentrating, and sleep difficulties cause ongoing distress. Recurrent thoughts, avoidant behavior and repeated requests for reassurance are seen. Worries may shift topics throughout the day. The content of excessive worry tends to be relevant to one’s age group and are pervasive and pronounced. Depression and other forms of anxiety are often seen along with GAD. It is important to distinguish other forms of anxiety which may appear to be generalized anxiety, as this will guide the treatment direction taken.
Stats: Age of onset is usually in adulthood (older than for other types of anxiety concerns) but it can be seen in teens and kids. Lifetime prevalence is 8-9%; roughly 2 out of every 50 people report experiencing this form of anxiety in their lifetime. Females are twice as likely as males to experience generalized anxiety disorder.
Definition: Experiences of intense fear or anxiety which can be triggered by many types of situations, including at least 2 of the following: fear of using any type of public transportation (e.g., cars, planes, buses), fear of being in open spaces (e.g., mall, parking lot), fear of being in enclosed spaces (e.g., stores, movie theatre), standing in line or being in a crowd, or going outside one’s home alone. Fear and anxiety is experienced in these situations, in anticipation of being in these situations, or in response to thinking about these situations. This fear is out of proportion to any actual danger to which an individual is exposed. Anxiety is accompanied by thoughts that an individual cannot escape from a feared situation, and/or that help is not available when experiencing high anxiety or panic. Individuals may also experience panic attacks in addition to agoraphobia concerns; both need to be addressed in the treatment plan. Avoidance is common and can range from mild avoidance, to severe (housebound). Secondary depression is common.
Stats: Approximately 1.7% of teens and adults (1 to 2 out of every 100 people) have agoraphobia. Prevalence is twice as common in females versus males.
Body Dysmorphic Disorder
Body Dysmorphic Disorder
Definition: Individuals with Body Dysmorphic Disorder (BDD) experience a preoccupation with one or more perceived flaws or defects about their physical appearance. These perceived flaws result in significant distress and anxiety for the individual, yet are typically not observable or appear only slight to others. These preoccupations are intrusive, unwanted and time consuming. Flaws can be one body part or area specifically, can be about multiple aspects of one’s appearance, can be about the whole body, and/or about body asymmetry. Appearance obsessions can lead to physical compulsions (such as mirror checking, body checking, excessive grooming, reassurance seeking, camouflaging, to name a few), or mental compulsions (such as comparing one’s personal appearance to others). Avoidance is common. Insight into body dysmorphic beliefs can be good, fair, poor or absent.
Stats: BDD affects roughly 1 out of every 50 people; from 1.7% to 2.9% of the population. Onset typically occurs in the teen years, and two-thirds have onset before 18 years. It is common for individuals with BDD to have other anxiety concerns as well as depression. It affects males and females almost equally.
Definition: PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome and is a diagnosis for kids who have a dramatic and very sudden onset (few days) of neuropsychiatric symptoms, including OCD and/or food restriction. These children can also display depression, irritability, anxiety, and difficulty with academics. Cause is unknown but thought to be triggered by infections, inflammatory reactions and metabolic disturbances.
PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection. PANDAS is considered a subset of PANS. Children who display a sudden acute onset of OCD and/or tic symptoms. Cause is thought to be triggered by a recent streptococcal infection. Children may also display uncontrollable emotions, irritability, and anxiety.
Stats: Lifetime prevalence is uncertain but thought to be 1 out of every 200 kids. Of kids diagnosed with OCD, estimates suggest that PANDAS may make up as much as 25 % of these cases. It is 2-4 times more common in males than females.
Health Anxiety (Somatic Symptom Disorder, Illness Anxiety Disorder)
Definition: An individual experiences one or multiple somatic or body focused symptoms that are distressing and result in interference with life. Concerns can be specific (for example, localized pain), or non-specific (fatigue). Symptoms may or may not have been given a medical explanation. Suffering is authentic whether or not the symptoms have a medical diagnosis. There tends to be an excessively high worry about illness above and beyond what may be expected (even when a medical diagnosis is made). Excessive time and energy is devoted to health concerns. Normal body sensations can be attributed to physical illness, and there is a fear that any action that might intensify the body sensations may damage the body in some way. Extra time is spent ruminating and thinking about how body sensations are harmful, and these reflections can become a central focus in life. Individuals may talk excessively about health concerns to others. A health focus can dominate life choices and relationships. While getting extra health consultations for medical concerns can at times be useful, individuals with health anxiety may seek excessive consultation and reassurance from doctors.
Stats: Prevalence is thought to be between 5%-7% of adults (5-7 out of every 100 people). Females tend to experience it more often than males.
Definition: Those with social anxiety or social phobia show fear reactions in social interactions (the fear reaction is out of proportion to the actual threat posed by the situation). The focus is typically about concerns of being evaluated negatively by others, including fear of embarrassment, being humiliated, worry about offending others or being rejected. Avoidance is common. Social situations, when faced, are endured with significant anxiety. Reassurance seeking from others is focused on reducing social fear. Individuals often struggle with assertiveness, and may have difficulty maintaining eye contact. Kids will display their anxiety differently than adults. With kids, social anxiety can be expressed by crying, emotional outbursts, clinging behaviors, not speaking, or physically freezing and not moving at all.
Stats: The 12 month prevalence rate is about 7 percent (about 3-4 out of every 50 people). The rate for kids and adults is roughly the same. Adult females experience more social anxiety than males at a rate about 2 to 1. Prevalence rates tend to decrease with age.
Tics and Tourette Syndrome
Definition: A tic is a sudden rapid motor movement, twitch or sound that an individual does repeatedly. Motor movements, for example, can include eye blinking, facial grimaces, head or shoulder jerk, or a combination of motor movements, to name just a few. Vocal tics can include snorting, barking, sniffing, throat clearing, chirping, random words, and others. Multiple motor tics and at least one vocal/phonic tic occurring intermittently over time but lasting for more than a year can qualify for a diagnosis of tourette syndrome. TS is an inherited neurological disorder characterized by sudden uncontrollable movements and/or sounds. Tics can be simple or complex. People with TS cannot stop the tics but may be able to delay some, at times, depending on TS severity and level of baseline anxiety. With this said, suppression of tics can be physically exhausting and can make it difficult to maintain focused attention. Tics are worsened by anxiety, stress, excitement and exhaustion. Tics reduce when a person is calm and focused on an activity. Tics are often preceded by a brief premonitory sensory urge, but tics are not performed in a deliberate effort to neutralize this urge or an obsession. There can be an overlap between complex tics and compulsions (Tourettic OCD), and as such, both diagnosis’ (TS and OCD) may be warranted and will have implications for treatment direction. It is important to assess for other conditions, including OCD, Attention Deficit Hyperactivity Disorder (ADHD), separation anxiety, and depression.
Stats: Typical age of onset is mid-childhood and tics can reach peak severity during early adolescence. Transient tics are common in childhood, and it less likely these tics will last into adulthood. Roughly 20 % of children have a tic disorder (1 in 5). Regarding tourettes, males are 3-5 times more likely to have tourette syndrome than females. In the general population, 0.6% (1 in 160 children) has tourettes. It is important to assess for co-occuring concerns like OCD and ADHD, sensory processing difficulties, and other forms of anxiety. Up to 60 % of Tourette sufferers report OCD symptoms. Roughly 50% of kids with OCD report tics, with 15% qualifying for a tourettes diagnosis. Up to 79% of people with tourettes have another mental health condition.
Definition: An immediate fear or anxiety that is due to the presence of a particular situation or object. These fears are intense and more severe than typical brief transient fears experienced by people. The amount of fear can vary depending on how close an individual is to the feared object or situation. The fear reaction can occur in anticipation of, or in the actual presence of, the object or situation. Panic attacks may accompany the specific phobia. The fear and anxiety reaction can be expressed differently between children and adults. Avoidance behavior is common. Examples include fear of vomiting (called emetophobia), dental phobias, fear of needles, blood or going to the doctor, fears of flying, driving on bridges, taking elevators, fear of tunnels, heights, fear of snakes or spiders or bees, to name a few. The fear and anxiety experienced is out of proportion to the actual danger that the object or situation presents. Anxiety and avoidance behavior is persistent and causes interference in areas of functioning. It is important to rule out other causes of these phobias, such as PTSD, OCD, separation fears or social anxiety, as this can impact treatment direction.
Stats: Approximately 7-9% of individuals experience one or more forms of specific phobia (12 month prevalence rate), or roughly 4 out of every 50 people. It is more common in females than males at a rate of 2:1. Specific phobias appear to be more common for teens than for younger children or adults, but any age can experience a specific phobia.
Definition: While chronic pain in itself is not a mental health diagnosis, there are many reasons why an individual may want to pursue support when dealing with unremitting physical pain. Those with chronic pain can experience increased emotional distress and life interference. Pain is a valid concern. It can be intermittent or persistent, burning, stabbing, tingling or a dull ache, to name a few. Pain can range from mild to severe. The location of an individual’s pain can have implications for physical functioning ability. Pain can interfere with one’s ability to focus and concentrate. An individual may have to make life changes as a result of chronic pain or a medical condition, which can be difficult. Interference in relationships can occur. Depression can arise if pain interferes with one’s ability to function in activities that traditionally provided a sense of pleasure or a sense of accomplishment. Chronic pain examples can include migraine and tension type headaches, joint pain such as arthritis or temporal mandibular dysfunction, nerve inflammation and/or injury such as peripheral neuropathy or complex regional pain syndrome, persistent post-surgery pain, conditions such as fibromyalgia, chronic fatigue syndrome, myofascial pain syndrome, chronic back or neck pain, and many others. Emotional reactions can be within the norm of what one would expect from a medical condition, however some individuals experience increased distress due to the intensity, duration, and location of the pain. Support and education about coping tools is useful, as chronic pain can be traumatic in how it influences mood, relationships, and life. Adjustments in life are needed to maintain quality of life. It is important to work with a multidisciplinary team, to understand what medical and medicine options are available to reduce the pain and/or address the medical condition, to learn distress tolerance coping tools, and to determine life adjustments that may be needed to reduce depression and regain quality of life if the pain cannot be significantly reduced.