Obsessive-Compulsive Disorder (OCD)

Now known to be among the most common of psychiatric disorders, OCD is characterized by obsessions and compulsions. Obsessions are intrusive and disturbing thoughts, impulses, or images, and can include fears of contamination and germs. Compulsions are repetitive behaviors, such as hand washing and checking. OCD is currently treated with medication and cognitive behavioral therapies. Here at Mount Sinai, ongoing projects increase our understanding of OCD and assist in the development of treatments to help OCD sufferers enjoy an increased quality of life.

At any given time we may have ongoing projects related to:

• Medication Studies
• Imaging (PET or MRI) Studies
• Immunologic Studies
• Neurosurgery
• Treatment Consortium for Refractory OCD

Body Dysmorphic Disorder (BDD)

Body Dysmorphic Disorder (BDD) is a disabling condition that had largely been ignored in the United States until recently. BDD is characterized by serious distress, preoccupation with some aspect of one's appearance (while others say that the individual looks fine), and compulsive behaviors or rituals, as well as surgical procedures, in an attempt to conceal or change the problematic body part or parts.

Any aspect of a person's appearance can be the focus of concern. For example, a normal-appearing person may think he or she has a bad complexion, deep wrinkles, misshapen teeth, a big nose, an asymmetrical body, or one that is not sufficiently muscular. Others may see none of these perceived flaws or only a slight anomaly.

Some clues to the presence of Body Dysmorphic Disorder include:

• Excessive preoccupation or concern with a slight or imagined flaw in appearance
• Excessive grooming or camouflaging the perceived flaw with clothing, make-up, a hat, one's hand, or one's posture
• Frequent checking of appearance in mirrors or a total avoidance of mirrors
• Frequent touching or measuring the feature of concern, or picking at the skin
• Excessive attention to the physical attractiveness of others, especially with regards to the feature of concern; constantly comparing one’s appearance to others
• Feeling very anxious around other people and avoiding social situations because of the perceived flaw
• Frequent asking for reassurance about one’s appearance
• Excessive reading or talking about the perceived flaw
• Using drugs, such as anabolic steroids, or excessive exercise or dieting to change one’s appearance
• Seeking help from cosmetic surgeons, dermatologists, or dentists to remedy the perceived flaw, even after doctors have said that treatment isn't necessary or advisable

Available Services at Mount Sinai
Evidence from recent experimental studies has given us a better understanding of the neurobiology of this disorder and how to treat it. In order to learn more about the disorder and improve treatment of people with BDD, we have several services available, including:

• A free screening evaluation and treatment study for adolescents ages 16 and younger
• A free psychiatric evaluation as part of a 24-week research study involving medication and cognitive behavioral therapy for adults over age 19
• A private consultation with a fee for service may be available for adults over age 19

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is generally used to describe a subset of children who have either a tic disorder, such as Tourette's Syndrome, or Obsessive Compulsive Disorder and whose tics, obsessions, or compulsions typically worsen dramatically following streptococcal infections. It may also describe children who have no prior history of tics, obsessions, or compulsions but who suddenly explode into such symptoms following a Group-A streptococcal infection.

At any given time we may have ongoing projects such as:

• Medication Studies
• Imaging (PET or MRI) Studies
• Immunologic Studies
• Genetic Studies

Binge Eating Disorder/Obesity

Binge Eating Disorder is a disorder in which people frequently eat large amounts of food while feeling a loss of control over their eating. Those with Binge Eating Disorder typically do not engage in behaviors to prevent weight gain, such as the vomiting often seen in Bulimia Nervosa or the excessive exercise seen in Anorexia Nervosa and/or Bulimia. Hence, many patients with Binge Eating Disorder are obese.

Frequent symptoms of Binge Eating Disorder include:

• Eating abnormally large amounts of food
• Eating much more rapidly than usual
• Eating until uncomfortably full
• Eating large amounts of food, even when not physically hungry
• Eating alone out of embarrassment at the quantity of food being eaten
• Feelings of disgust, depression, or guilt after overeating
• Feeling out of control with eating
• Distress over the eating

Obesity is a major complication of Binge Eating Disorder. Risks associated with obesity include diabetes, high blood pressure, high cholesterol levels, gallbladder disease, heart disease, joint problems, and certain types of cancer. People with Binge Eating Disorder are extremely distressed by their binge eating. Most have tried to control it on their own with limited success. Some people miss work, school, or social activities to binge eat. Obese people with Binge Eating Disorder often feel bad about themselves, are preoccupied with their appearance, and may avoid social gatherings. Most feel ashamed and try to hide their problem. Often they are so successful that close family members and friends don't know they binge eat.

Borderline Personality Disorder (BPD)

Borderline Personality Disorder (BPD) is a psychiatric illness that is characterized by a pattern of instability in relationships, self-image, and mood, and impulsivity in a variety of situations. People who suffer from BPD very often have an intense fear of abandonment, and they may frantically try to avoid abandonment. They generally have unstable relationships with family members, friends, and romantic interests. They may have an unstable self-image as well. They frequently engage in impulsive behaviors such as reckless driving, unsafe sex, or substance abuse. Instability in mood and chronic feelings of emptiness are also common among BPD sufferers. They may be prone to rage attacks as well.

BPD can lead to significant impairment. The disorder accounts for approximately 20 percent of inpatient psychiatric hospitalizations. About 10 percent of patients with BPD commit suicide. Many BPD patients may also cut or burn themselves.

Some clues to the presence of Borderline Personality Disorder include:

• Unstable, intense, "love-hate" relationships
• Feeling abandoned
• Rapid or frequent mood swings
• Rage attacks in response to interpersonal slights or frustrations or difficulty in controlling anger
• Risk taking and impulsiveness, such as gambling, shopping sprees, reckless driving, binge eating, substance abuse
• Feeling depressed, sad, or empty
• Zoning out under stress
• Intentional self-mutilating behaviors, like cutting or burning oneself
• Recurring suicide attempts
• Addictive behaviors

Historically, it has been very difficult to successfully treat BPD. However, recent developments in the study of the neurobiology of this disorder have given clinicians new tools to help patients. We currently have several services available for people who have BPD.

Pathological Gambling (PG)

Pathological gambling is an understudied disorder that causes significant distress to its many sufferers. However, awareness of pathological gambling as a major public health problem has been rising secondary to vastly increased opportunities for legal and computerized/interactive gambling.

Pathological gambling is characterized by a progressive failure to resist impulses to gamble. It significantly disrupts functioning in multiple spheres of personal and family life and vocation. There is also a noted increase of tension prior to gambling, and gambling usually increases in times of stress. At the time of the behavior, there is also a sense of gratification, release, or pleasure. Unfortunately, the secondary problems that result from gambling, like debt, often intensify the behavior, and thus an unchecked downward spiral may occur with compounding negative effects.

We currently have several studies helping us to learn more about how to successfully treat this disorder.

At any given time we may have ongoing projects related to:

• Medication Studies
• Imaging (PET or MRI) Studies
• Immunologic Studies
• Neurotransmitter Studies

Internet Addiction

The Internet clearly has a role to play in today's information age and will become increasingly important in our communications, work life, and daily activities. However, like other powerful media, the Internet is also an avenue for abuse, leading people to exhibit behaviors that are counterproductive, isolating, and destructive to themselves and their normal functioning.

Some clues to the presence of Internet Addiction:

• Staying online longer than intended
• Neglecting household chores to spend more time online
• Often preferring the excitement of the Internet to intimacy with a partner
• Frequently forming new relationships with fellow online users
• Family or friends complaining about the amount of time spent online
• School or job performance suffering because of the amount of time you spend online
• Failing at attempts to cut down the amount of time spent online
• Trying to hide amount of time spent online
• Feeling depressed, moody, or nervous offline, which goes away once back online

Please contact us to find out how you can participate in studies to advance our knowledge of Internet Addiction.

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder is characterized by persistent, excessive and hard to control worries and anxiety. People with GAD often worry excessively about many issues or events (such as health, money, family, or work) over long periods of time.

Symptoms of GAD include:

• Restlessness or feeling keyed up or on edge
• Being easily fatigued
• Difficulty concentrating or mind going blank
• Irritability
• Muscle tension
• Sleep disturbance (difficulty falling or staying asleep, or restless and unsatisfying sleep)

People with GAD may feel tension, fatigue, insomnia, and impaired concentration, and their social, occupational, or other important areas of life may be negatively impacted.

Please contact us to find out how you can participate in studies to advance our knowledge of Generalized Anxiety Disorder.