Erin Harris

Anxiety disorders are characterized by excessive fear and anxiety and related behavioral disturbances. According to the DSM-5-TR, anxiety disorders differ based on the types of objects or situations that induce fear, anxiety, or avoidance behavior, as well as the associated cognitive ideation (APA, 2022).

Anxiety Disorders Under the DSM-5 Umbrella:

1. Generalized Anxiety Disorder (GAD):
   Persistent and excessive worry about various domains (e.g., school performance, social situations, health) that is difficult to control and lasts for at least six months.

2. Separation Anxiety Disorder:
   Developmentally inappropriate fear or anxiety concerning separation from attachment figures. Common in children and adolescents.

3. Social Anxiety Disorder (Social Phobia):
   Marked fear or anxiety about one or more social situations in which the individual may be scrutinized or negatively evaluated by others.

4. Specific Phobias:
   Intense fear or anxiety about a specific object or situation (e.g., heights, animals, flying), leading to avoidance behavior.

5. Panic Disorder:
   Recurrent unexpected panic attacks, which are sudden periods of intense fear that peak within minutes and include physical and cognitive symptoms (e.g., palpitations, fear of losing control).

6. Agoraphobia:
   Fear of being in situations where escape might be difficult or help might not be available during panic-like symptoms.

7. Selective Mutism:
   Consistent failure to speak in specific social situations (e.g., school) despite speaking in other situations.

Signs & Symptoms of Anxiety Disorders:

• Restlessness or feeling keyed up/on edge

• Fatigue

• Difficulty concentrating

• Irritability

• Muscle tension

• Sleep disturbances

• Physical complaints (headaches, stomachaches)

• Avoidance of feared situations or people
  
  

School-Specific Indicators:

Teachers May Notice:

• Frequent nurse visits without medical causes

• Poor academic performance despite potential

• Perfectionism or excessive reassurance seeking

• Avoidance of presentations, group work, or social situations

• Difficulty focusing in class

Coaches May Notice:

• Avoidance of practices or games

• Somatic complaints (e.g., headaches, nausea) before events

• Performance anxiety or breakdowns under pressure

• Withdrawal from peers during team events

Cafeteria Monitors/Staff May Notice:

• Avoidance of lunch areas (linked with social anxiety)

• Eating alone or not eating at all

• Appearing anxious, restless, or distressed in noisy environments

(NMIH, n.d.)

How School Personnel Should Respond:

If a Student Shares an Outcry or Concerning Behavior Is Observed:

• Stay Calm and Supportive: Show empathy and remain nonjudgmental. Let the student know you're glad they shared.

• Validate Feelings: “It sounds like this has been really difficult for you. Thank you for trusting me.”

• Do Not Promise Confidentiality: Explain that you may need to involve others to ensure their safety.

• Document and Report: Follow your school/district’s referral protocol immediately.

Referral & Reporting Protocol:

1. Immediate Concern or Risk (e.g., panic attacks, suicidal ideation):

   • Contact the school crisis response team or designated mental health professional.

   • Do not leave the student alone.

   • Call emergency services (911) if there is imminent danger.

2. Non-Emergency Concerns:

   • Refer to school counselor, school psychologist, or mental health provider.

   • Document behavior and maintain communication with mental health personnel.

   • Inform guardians as appropriate, following FERPA and school policy.

3. Third-Party Reports:

   • Take all reports seriously, even if from another student.

   • Document the report, respond with concern, and refer the reported student to the school counselor or mental health team.

(Silverman, Pina, & Viswesvaran, 2008)

My Role as an LPC in Private Practice:

As a Licensed Professional Counselor, my role is to:

• Conduct a comprehensive intake assessment, including standardized anxiety measures (e.g., GAD-7, SCARED).

• Evaluate for co-occurring conditions such as depression, ADHD, trauma, or substance use.

• Collaborate with parents, school personnel, and other professionals (with appropriate releases).

• Develop a personalized treatment plan, which may include:

  • Cognitive Behavioral Therapy (CBT) to help the client recognize and reframe anxious thoughts

  • Psychoeducation to teach clients and families about anxiety

  • Exposure therapy (for specific phobias or social anxiety)

  • Relaxation and mindfulness techniques

• Provide referrals for medication evaluation if needed (e.g., to a psychiatrist)

• Engage in ongoing assessment and monitoring of progress

(NMIH, n.d.)

Evidence-Based Strategy: Cognitive Behavioral Therapy (CBT)

CBT is one of the most widely researched and effective treatments for anxiety disorders in children and adolescents. It helps clients understand the relationship between thoughts, feelings, and behaviors, and teaches coping strategies such as relaxation, problem-solving, and cognitive restructuring.

“CBT has demonstrated efficacy in reducing anxiety symptoms and improving functioning in children and adolescents with a variety of anxiety disorders” (Silverman, Pina, & Viswesvaran, 2008).

For Further Information, explore:

Anxiety Disorders

• National Institute of Mental Health (NIMH) – Anxiety Disorders
  https://www.nimh.nih.gov/health/topics/anxiety-disorders
  
  Includes symptoms, types, treatment, and research-based facts for professionals and the public.

Obsessive Compulsive Disorder is marked by obsessions (intrusive, unwanted thoughts, urges, or images) and/or compulsions (repetitive behaviors or mental acts)(APA, 2013).

Compulsions are often performed in response to obsessions or according to rigid rules.

Umbrella Related disorders

According to the DSM-5 (APA, 2013), this diagnostic category includes the following disorders:

• Body Dysmorphic Disorder - A disorder involving obsessive focus on a perceived flaw in physical appearance, often leading to repetitive behaviors like mirror checking or grooming. 

• Hoarding Disorder - Persistent difficulty discarding possessions, resulting in clutter that interferes with daily living and safety. 

• Trichotillomania (Hair-Pulling) - A condition where individuals repeatedly pull out their hair, causing noticeable hair loss and distress. 

• Excoriation (Skin-Picking) - Repetitive skin picking that results in skin damage and attempts to stop are often unsuccessful. 

• OCD induced by substances, medical conditions, or unspecified - OCD-like symptoms that don't meet full diagnostic criteria but still cause significant distress or impairment. 

Signs/Symptoms  (Baldridge & Piotrowski, 2024)

Common Signs & Symptoms 

Obsessions

• Persistent, intrusive thoughts (e.g., contamination, harm, order)

• Intense anxiety triggered by the thoughts

Compulsions

• Repetitive behaviors (handwashing, checking, counting)

• Mental rituals (silent prayers, repeating phrases)

• Temporary relief, but cycle continues

Other Disorders

• Hair pulling or skin picking despite attempts to stop

• Preoccupation with perceived physical flaws

• Accumulation of items due to inability to discard

Potential Social, Emotional, and Academic impacts of the disorders (Brock, Rizvi, & Hany, 2024) 

Social, Emotional, and Academic Impacts

Social:

• Isolation due to embarrassment or avoidance

• Difficulty maintaining friendships

• Fear of judgment or rejection

Emotional:

• Anxiety, shame, depression

• Low self-esteem

• Frustration due to uncontrollable thoughts or behaviors

Academic:

• Difficulty concentrating due to intrusive thoughts

• Perfectionism leading to incomplete or late work

• Avoidance of school due to anxiety or social fears

Specific Needs Students/Clients (Baldridge & Piotrowski, 2024)

Emotional safety and non-judgmental support

Counseling focused on anxiety reduction and coping strategies

Academic accommodations when appropriate

• Extended time on assignments

• Reduced distraction

• Modified workload

Psychoeducation for family, teachers, and peers

Consistent support from school staff

Access to clinical therapy if symptoms are severe

Impact on Development and Success (Brock, Rizvi, & Hany, 2024) 

Cognitive Development:

• Intrusive thoughts may disrupt learning and memory

• Perfectionism may lead to fear of failure or giving up

Social Development:

• Social withdrawal limits development of peer relationships

• Increased risk of peer rejection or bullying

Emotional Development:

• Chronic anxiety may contribute to depression

• Emotional regulation difficulties

Long-Term Success:

• Without support, students may experience academic underachievement

• Delayed social skills development

• Increased risk for continued mental health challenges into adulthood

For additional information, explore:

Obsessive-Compulsive Disorder (OCD)

• International OCD Foundation (IOCDF)
  https://iocdf.org/about-ocd/

Trusted source for information, treatment guides, and support tools.

Trauma- and stressor-related disorders are a category of mental health conditions directly related to exposure to a stressful or traumatic event (APA, 2013). Individuals who experience these disorders have been confronted with overwhelming situations that exceed their coping abilities, leading to a wide range of emotional, cognitive, behavioral, and physiological responses. These disorders are unique because, unlike many other mental health conditions, their cause is linked to a specific stressor or traumatic experience.

The Trauma- and Stressor-Related Disorders “Umbrella”

According to the DSM-5 (APA, 2013), this diagnostic category includes the following disorders:

• Posttraumatic Stress Disorder (PTSD)

• Acute Stress Disorder (ASD)

• Adjustment Disorders

• Reactive Attachment Disorder (RAD)

• Disinhibited Social Engagement Disorder (DSED)

• Other Specified Trauma- and Stressor-Related Disorder

• Unspecified Trauma- and Stressor-Related Disorder

These disorders vary in presentation, but all share a core feature: the presence of psychological distress following exposure to a traumatic or stressful event.

Specific Signs/Symptoms (NCTSN, 2020) 

Emotional & Psychological Symptoms:

• Intrusive thoughts, memories, or flashbacks of the trauma

• Nightmares or disturbed sleep

• Anxiety, fear, or hypervigilance

• Avoidance of reminders of the trauma

• Emotional numbing or detachment

• Mood swings, irritability, or anger outbursts

• Feelings of guilt, shame, or hopelessness

Behavioral Symptoms:

• Avoidance of people, places, or activities associated with the trauma

• Risky or impulsive behavior (especially in adolescents) (SAMHSA, 2014) 

• Social withdrawal or isolation

• Difficulty trusting others

Physical/Somatic Symptoms:

• Headaches, stomachaches, or other unexplained physical complaints

• Changes in appetite

• Fatigue or restlessness

• Increased startle response

School-Specific Symptoms:

• Difficulty concentrating or retaining information

• Decline in academic performance

• School refusal or frequent absences

• Disengagement in classroom participation

• Frequent visits to the nurse without medical cause

• Difficulty following instructions or completing assignments

Potential Social, Emotional, and Academic Impacts of the Disorders (NCTSN, 2020) 

Social Impacts:

• Trouble forming or maintaining friendships

• Increased conflict with peers or authority figures

• Social withdrawal and isolation

• Difficulty trusting others or building rapport

Emotional Impacts:

• Increased risk of anxiety, depression, self-harm, or suicidal ideation

• Emotional dysregulation (frequent anger, sadness, fear)

• Persistent feelings of shame, guilt, or worthlessness

Academic Impacts:

• Inconsistent attendance due to avoidance or anxiety

• Lower grades and incomplete assignments

• Difficulty with concentration, memory, and organization

• Limited participation due to fear of judgment or triggers in the environment

Specific Needs of Students/Clients with Trauma- and Stressor-Related Disorders (CDC, 2023) 

• Safe, predictable, and supportive environments

• Trauma-informed counseling and teaching approaches

• Consistent relationships with trusted adults

• Development of emotional regulation and coping skills

• Psychoeducation for students, families, and school staff about trauma's effects

• Flexible academic supports (extended time, modified workload, counseling access)

Impact on Development and Success (NCTSN, 2020)

• Trauma-related disorders can significantly hinder emotional, social, and cognitive development. 

• Early or repeated exposure to trauma may disrupt attachment, limit the ability to regulate emotions, and impair memory, attention, and executive functioning. 

• Students and clients with trauma histories may show delays in developmental milestones, decreased academic achievement, and difficulty forming healthy relationships. Without intervention, trauma-related disorders can contribute to chronic mental health concerns into adulthood, including depression, substance use, and relationship difficulties.

However, with timely and appropriate support, students and clients can show remarkable resilience, heal from traumatic experiences, and develop into emotionally healthy, socially connected, and academically capable individuals.

For additional information, explore:

Trauma and Stressor-Related Disorders (incl. PTSD)

• National Center for PTSD (U.S. Dept. of Veterans Affairs)
  https://www.ptsd.va.gov/
  
  Research-based PTSD info for clinicians, clients, educators, and families.

Bipolar and related disorders are a category of mental health conditions characterized by significant mood disturbances, including episodes of mania, hypomania, depression, and in some cases, mixed states (American Psychiatric Association [APA], 2022). These disorders fall under the Neurodevelopmental and Mood Disorders umbrella in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) and include:

• Bipolar I Disorder - Characterized by at least one manic episode, which may be preceded or followed by hypomanic or major depressive episodes. The manic episode must last at least 7 days (or any duration if hospitalization is necessary) and cause significant impairment in functioning (APA, 2022). 

• Bipolar II Disorder - Involves at least one hypomanic episode (lasting at least 4 days) and at least one major depressive episode, but no history of full manic episodes. Hypomania is less severe than mania and doesn’t cause marked impairment (APA, 2022). 

• Cyclothymic Disorder - A chronic mood disorder involving numerous periods of hypomanic and depressive symptoms over at least 2 years (1 year for children/adolescents), that don’t meet full criteria for a hypomanic or major depressive episode (APA, 2022).

• Other Specified or Unspecified Bipolar and Related Disorders - Used when individuals exhibit bipolar-like symptoms that cause significant distress or impairment but don’t meet the full criteria for any specific bipolar disorder. Examples include short-duration hypomanic episodes or hypomania without depression (APA, 2022). 

• Substance/Medication-Induced Bipolar Disorder - Mood disturbances (mania, hypomania, or depression) that are directly caused by substance use, medication, or withdrawal. The symptoms are not better explained by a primary mood disorder and occur during or soon after substance exposure (APA, 2022).

• Bipolar Disorder Due to Another Medical Condition - Significant mood symptoms (manic or depressive) that are judged to be a direct physiological result of another medical condition, such as multiple sclerosis, stroke, or Cushing’s disease (APA, 2022).
  
  

Signs and Symptoms

Common features across the bipolar spectrum include:

• Manic Episodes: Elevated or irritable mood, inflated self-esteem, decreased need for sleep, increased talkativeness, distractibility, risky behaviors, and increased goal-directed activity (APA, 2022).

• Hypomanic Episodes: Similar to mania, but less severe and not requiring hospitalization.

• Depressive Episodes: Low mood, anhedonia, fatigue, sleep/appetite changes, feelings of worthlessness or guilt, suicidal ideation.

• Mixed Features: Symptoms of both mania and depression may co-occur, complicating diagnosis and treatment (Tondo et al., 2018).

Social, Emotional, and Academic Impact

Youth with bipolar and related disorders may experience:

• Social difficulties: Trouble forming and maintaining relationships due to mood instability, impulsivity, or irritability.

• Emotional dysregulation: Intense mood swings can cause confusion, shame, or frustration, often resulting in conflict or isolation (Abrams, 2022).

• Academic struggles: Cognitive impairments (e.g., attention, memory, executive functioning) and mood episodes can lead to poor academic performance, inconsistent attendance, or disciplinary issues (Goldstein et al., 2015).

These students may require accommodations, such as:

• Access to mental health support or school counseling

• Flexibility in deadlines and workload

• Behavioral intervention plans and Individual Education Plans (IEP)

• Family and staff education to reduce stigma and foster support

Developmental and Long-Term Impact

Untreated or late-diagnosed bipolar disorders can significantly impact developmental milestones, including:

• Delayed emotional maturity and impaired self-regulation

• Interrupted education or career pathways due to hospitalizations or academic failures

• Increased risk for substance use, legal issues, and suicidality (Miklowitz et al., 2020)

Early intervention and coordinated care—including psychoeducation, therapy, and medication management—are critical for improving long-term outcomes and promoting resilience, independence, and social-emotional competence (Singh et al., 2020).

Understanding IDEA vs. Section 504 (LD Online, 2022)

The Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act are two key federal laws that support students with disabilities in U.S. schools, but they differ in scope, services, and protections.

🔹 IDEA

• A special education law offering services to students (ages 3–21) who meet specific disability categories (e.g., autism, learning disabilities, emotional disturbance).

• Requires an Individualized Education Program (IEP), measurable goals, and regular progress tracking.

• Offers related services (e.g., speech therapy, counseling).

• Evaluation requires parental consent and is more comprehensive.

• Provides strong due process protections, including "stay-put" rights during disputes.

🔹 Section 504

• A civil rights law that protects students with any physical or mental impairment that substantially limits a major life activity (e.g., learning, walking, breathing).

• Does not require specialized instruction; focuses on equal access through accommodations.

• Requires a 504 Plan, not an IEP.

• Evaluations are less formal; parental consent is not required.

• Fewer procedural safeguards than IDEA; disputes are handled locally and enforced by the Office for Civil Rights.

🔹 Key Differences

• Eligibility: IDEA has more specific criteria; 504 is broader.

• Services: IDEA offers both accommodations and specialized instruction; 504 focuses on accommodations only.

• Funding: IDEA provides federal funding; Section 504 does not.

• Scope: IDEA covers only school-aged students; Section 504 extends across the lifespan.

For Additional Information, explore:

• National Alliance on Mental Illness (NAMI) – Bipolar Disorder
  https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder
  
  Offers educational material, support resources, and professional treatment approaches.

Depressive Disorders 

Depressive disorders are a group of mental health conditions characterized by persistent feelings of sadness, emptiness, or irritability, often accompanied by somatic and cognitive changes that significantly impair an individual's functioning (APA, 2013). 

Types of Depressive Disorders (DSM-5):
The depressive disorders umbrella includes the following specific diagnoses (Bains & Abdijadid, 2023):

• Major Depressive Disorder (MDD): At least two weeks of depressed mood or loss of interest, with additional cognitive and physical symptoms.

• Persistent Depressive Disorder (Dysthymia): Chronic depression lasting at least two years (one year in children/adolescents).

• Disruptive Mood Dysregulation Disorder: Severe temper outbursts and persistent irritability in children.

• Premenstrual Dysphoric Disorder: Mood symptoms related to the menstrual cycle.

• Substance/Medication-Induced Depressive Disorder: Depression caused by substance use or withdrawal.

• Depressive Disorder Due to Another Medical Condition: Direct physiological cause (e.g., thyroid issues).

• Unspecified Depressive Disorder: Depressive symptoms that do not meet full criteria for the above.

Signs and Symptoms of Depressive Disorders

According to the DSM-5 and clinical literature, individuals with depressive disorders may experience some or all of the following (Bains & Abdijadid, 2023):

• Mood-related symptoms:

  • Persistent sadness or low mood

  • Irritability (especially in children and adolescents)

  • Loss of interest or pleasure in activities (anhedonia)

• Cognitive and behavioral symptoms:

  • Difficulty concentrating or making decisions

  • Feelings of guilt, worthlessness, or hopelessness

  • Recurrent thoughts of death or suicide

• Physical symptoms:

  • Changes in sleep patterns (insomnia or hypersomnia)

  • Changes in appetite or weight

  • Fatigue or low energy

  • Psychomotor agitation or slowing

• Functional impact:
  These symptoms must cause clinically significant distress or impairment in social, academic, or occupational functioning.
  
  

Potential Social, Emotional, and Academic Impacts

Students or clients with depressive disorders may experience a wide range of challenges across settings (Lyness et al., 2006; Green et al., 2010):

• Social impacts:

  • Withdrawal from peers, family, or social activities

  • Difficulty forming or maintaining relationships

  • Increased interpersonal conflict or isolation

• Emotional impacts:

  • Low self-esteem and self-worth

  • Emotional numbness or heightened sensitivity

  • Anxiety or irritability, especially in youth

• Academic impacts:

  • Poor concentration or memory issues

  • Missed assignments, absenteeism

  • Decreased academic performance or motivation

  • Test anxiety and reduced classroom participation
    
    

Specific Needs in the Educational or Counseling Setting (Bains & Abdijadid, 2023)

• Instructional support:

  • Extended time for tests/assignments

  • Preferential seating

  • Reduced workload or modified assignments when necessary

• Mental health support:

  • Access to counseling or school psychologist

  • Regular emotional check-ins or mentorship programs

• Environmental accommodations:

  • Quiet or reduced-stimulation spaces for breaks

  • Clear routines and structured expectations

  • Frequent feedback and positive reinforcement
    
    

Developmental and Functional Impact (Bains & Abdijadid, 2023)

If left untreated, depressive disorders can negatively affect:

• Developmental outcomes:

  • Delayed social-emotional development

  • Impaired executive functioning (planning, decision-making)

• Academic success:

  • Higher risk of grade repetition or school dropout

  • Lower rates of college enrollment or completion

• Long-term outcomes:

  • Increased risk of substance use, self-harm, or suicidal behavior

  • Chronic mental health issues extending into adulthood

  • Lower overall life satisfaction and occupational achievement (Ratheesh et al., 2017)

Accommodation (Ellis, 2021)

Definition:
An accommodation changes how a student learns or accesses the curriculum without changing the learning expectations or content. It levels the playing field so students can demonstrate what they know.

Key Features:

• Does not reduce learning expectations

• Changes environment, presentation, timing, response method, or tools

• Can be used for any student who needs support

Examples:

• Extended time on tests

• Audiobooks instead of printed text

• Preferential seating

• Use of a calculator or word processor

• Small group testing

Modification (Ellis, 2021)

Definition:
A modification changes what a student is expected to learn. It lowers or alters the curriculum to better fit the student’s needs.

Key Features:

• Changes content, assignments, or grading scale

• Used only when necessary, often written into an IEP

• Student learns less or different material

Examples:

• Fewer questions on a test

• Alternative assignments or projects

• Graded on a different scale

• Work from a different grade level

Intervention (Ellis, 2021)

Definition:
An intervention is a targeted instructional strategy designed to help a student learn a specific skill or concept they are struggling with. It’s part of progress monitoring and skill-building, often in small group or one-on-one settings.

Key Features:

• Intended to teach or reteach a specific skill

• Often short-term and data-driven

• May lead to referrals for further support (like SPED evaluation)

Examples:

• Reading fluency programs

• Small group math instruction

• Study skills groups

• Behavior or social-emotional supports

For addtional information, explore:

Depressive Disorders

• Mayo Clinic – Depression (Major Depressive Disorder)
  https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
  
  

• NIMH – Depression
  https://www.nimh.nih.gov/health/topics/depression

Eating disorders are defined as persistent disturbances in eating or eating-related behaviors that result in significant impairment in physical health or psychosocial functioning. These disorders are often characterized by severe preoccupations with food, body weight, or body shape, and they can include behaviors such as extreme restriction of food intake, binge eating, purging, or avoidance of food due to sensory concerns or fear of adverse consequences (APA, 2013). 

Included Disorders:

• Anorexia Nervosa

• Bulimia Nervosa

• Binge Eating Disorder (BED)

• Pica

• Rumination Disorder

• Avoidant/Restrictive Food Intake Disorder (ARFID)

(DSM-5-TR, APA, 2022)

Elimination disorders involve inappropriate elimination of urine or feces, usually diagnosed in childhood or adolescence, not due to a medical condition (APA, 2022).

Included Disorders:

• Enuresis (urinary incontinence)

• Encopresis (fecal incontinence)

Anorexia Nervosa

Definition:
Restriction of energy intake leading to significantly low weight, intense fear of gaining weight, and body image disturbance.

Signs & Symptoms:

• Extreme weight loss

• Preoccupation with food/calories

• Refusing to eat or denying hunger

• Excessive exercise

• Social withdrawal

Audience-Specific Signs (e.g., Teachers, Coaches, Nurses):

• Skipping meals or “forgetting” lunch

• Wearing baggy clothes

• Fatigue during physical activity

• Frequent trips to the nurse

• Obsessive talk about weight or food

Bulimia Nervosa

Definition:
Recurrent episodes of binge eating followed by inappropriate compensatory behaviors (vomiting, laxatives, excessive exercise).

Signs & Symptoms:

• Frequent bathroom trips after meals

• Swollen cheeks/jaw

• Calluses on knuckles

• Mood swings

• Dental issues (due to acid exposure)

Audience-Specific Signs:

• Teachers may notice sudden grade drops or impulsive behavior

• Coaches may see dehydration or overtraining

• Cafeteria staff may notice large food consumption quickly, followed by disappearance

Binge Eating Disorder (BED)

Definition:
Recurrent episodes of eating unusually large amounts of food in a short period with a sense of loss of control (APA, 2022).

Signs & Symptoms:

• Eating in secret

• Rapid weight gain

• Distress or shame after eating

• Hoarding food

Audience-Specific Signs:

• Teachers may observe emotional outbursts

• Friends may notice missing food or emotional eating

• School counselors may hear shame-based self-talk

Other Feeding/Eating Disorders

ARFID:
Avoidance of food due to sensory issues or fear of choking without body image concerns (APA, 2022).
Pica:
Eating non-food items (e.g., dirt, hair, paint).
Rumination Disorder:
Regurgitating food and re-chewing/swallowing it.

Signs (for school staff):

• Eating paper, erasers (Pica)

• Spitting up food during or after meals (Rumination)

• Strong reactions to certain food textures (ARFID)

Elimination Disorders – Enuresis

Definition:
Involuntary urination (bedwetting or daytime wetting) after the age where continence is expected (age 5+) (APA, 2022).

Signs & Symptoms:

• Wet clothes

• Odor

• Embarrassment or shame

• Avoidance of sleepovers or long trips

Elimination Disorders – Encopresis

Definition:
Repeated passage of feces into inappropriate places after the age of 4 (APA, 2022).

Signs & Symptoms:

• Soiled underwear

• Withholding bowel movements

• Constipation

• Hiding dirty clothing

Audience-Specific Signs (e.g., Teachers, School Staff):

• Increased visits to nurse’s office

• Avoidance of bathroom

• Emotional withdrawal or bullying

Response Protocol – Suspected Case or Outcry (Cooper & Stewart, 2008)

Step-by-Step for School Personnel:

1. Stay calm, supportive, and nonjudgmental

2. Don’t try to diagnose – express concern and care

3. Document observations (dates, times, behaviors)

4. Refer to appropriate professional (e.g., school counselor, nurse, crisis team)

5. Follow school’s reporting and confidentiality guidelines

6. In crisis (e.g., suicidal thoughts, serious medical risk):

   • Contact designated crisis response

   • Call 911 if needed

Third-Party Concerns:

• Validate their concern

• Ensure follow-up with appropriate staff

• Maintain confidentiality and respect

Evidence-Based Treatment

Strategy: Cognitive Behavioral Therapy – Enhanced (CBT-E) (Fairburn et al., 2015). 

• Adaptable to Anorexia, Bulimia, and BED

• Addresses distorted thinking around food/body image

• Involves behavior modification, thought restructuring, relapse prevention

Evidence:
CBT-E is the first-line treatment for Bulimia and BED, and effective with some forms of Anorexia (Fairburn et al., 2015).

Example in LPC Practice:

• Use food journals to monitor eating episodes

• Challenge black-and-white thinking (e.g., “I ruined my diet, so I might as well binge”)

• Develop coping skills for emotional triggers

Modeling Healthy Behaviors (for Schools & Families)

• Emphasize body diversity and functionality, not appearance

• Avoid labeling foods as “good” or “bad”

• Promote regular, balanced meals

• Discourage dieting language or weight-shaming

• Respond calmly and supportively to accidents (in elimination disorders)

• Teach emotional regulation and coping skills

• Use positive reinforcement, not punishment
  
  

For addtional information, explore:

Feeding & Eating Disorders

• National Eating Disorders Association (NEDA)
  https://www.nationaleatingdisorders.org/
  
  Great for both clinical insight and school staff awareness; includes screening tools.
  
  

• NIMH – Eating Disorders
  https://www.nimh.nih.gov/health/topics/eating-disorders
  
  

Elimination Disorders

• HealthyChildren.org (AAP) – Enuresis & Encopresis
  https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Elimination-Problems.aspx
  
  Parent- and educator-friendly resource from the American Academy of Pediatrics.

Dissociative disorders are a group of mental health conditions that involve disruptions in memory, identity, emotion, perception, behavior, and sense of self. These disruptions are often the result of psychological trauma and are a defense mechanism to help the individual cope (APA, 2014).

Disorders under the Dissociative Umbrella (DSM-5):

1. Dissociative Identity Disorder (DID)
   Characterized by the presence of two or more distinct identity states or personalities that may control the person’s behavior at different times.

2. Dissociative Amnesia
   Involves an inability to recall important autobiographical information, typically related to trauma or stress, that is too extensive to be explained by ordinary forgetfulness.

3. Depersonalization/Derealization Disorder
   Involves persistent or recurrent feelings of detachment from one’s body (depersonalization) or surroundings (derealization), while reality testing remains intact.

Signs and Symptoms

• DID: Sudden shifts in behavior or preferences, memory lapses, referring to themselves in different names, hearing internal voices.

• Dissociative Amnesia: Inability to remember specific personal information or events, wandering or confusion.

• Depersonalization/Derealization Disorder: Feeling emotionally numb or like one is observing themselves from outside the body, environment feels unreal.

Audience-Specific Indicators (for School Personnel) (International Society for the Study of Trauma and Dissociation, 2011)

Coaches may notice:

• A student suddenly unable to recall routines, plays, or interactions.

• Shifts in physical behavior or personality across practices.
  
  

Teachers may notice:

• Frequent “spacing out” or lack of presence in class.

• Conflicting narratives in student writing or discussion.

• Changes in handwriting or speaking tone.

Cafeteria monitors may notice:

• Student appearing dazed or confused.

• Student sitting alone and unresponsive to peers.

How to Respond if You Suspect Dissociative Symptoms

If a student discloses symptoms or you observe signs: 

1. Stay calm and nonjudgmental. Use reflective listening: "It sounds like you're feeling a bit disconnected or confused today."

2. Do not try to diagnose. Instead, focus on validating the student's emotions and connecting them to the appropriate resource.

3. Make a referral to the school counselor or designated mental health provider as soon as possible.

If another student or staff member shares a concern:

• Listen supportively and take it seriously.

• Document the concern factually and share it with the appropriate mental health or school administrator.

• Maintain confidentiality, but never secrecy when safety is at risk.

If there is a crisis (e.g., the student is disoriented, wandering, or expressing suicidal thoughts):

1. Notify the school counselor and/or crisis team immediately.

2. Do not leave the student unattended.

3. Contact emergency services if necessary (911), and follow school crisis protocol.

(Dell & O’Neil, 2009) 

Counselor's Role (LPC in Private Practice)

As an LPC, I would:

• Conduct a comprehensive clinical interview using trauma-informed approaches.

• Use validated assessment tools, such as the Dissociative Experiences Scale (DES-II) to screen for dissociative symptoms.

• Rule out medical causes in collaboration with a primary care provider or psychiatrist.

Treatment Plan Includes:

• Establishing safety and trust with the client.

• Cognitive Behavioral Therapy (CBT) and Trauma-Focused CBT to address maladaptive thoughts and behaviors.

• Grounding techniques for managing dissociation in the moment.

• Psychoeducation about dissociation and trauma.

• When necessary, referral to a psychiatrist for medication management (e.g., for comorbid PTSD or depression).

(Brand, Schielke, Brams, & DiNapoli, 2019) 

For additional information, explore:

Dissociative Disorders

• American Psychiatric Association – Dissociative Disorders
  https://www.psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders

Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. Individuals may experience psychosis (loss of contact with reality), which includes hallucinations (seeing or hearing things that aren’t there) and delusions (fixed false beliefs). It typically emerges between the late teens and early 30s, with rare cases of childhood-onset.

According to the DSM-5-TR, schizophrenia is diagnosed when two or more of the following are present for at least one month, with continuous signs of disturbance lasting at least six months:

• Delusions

• Hallucinations

• Disorganized speech

• Grossly disorganized or catatonic behavior

• Negative symptoms (e.g., diminished emotional expression, avolition)

Note: At least one symptom must be delusions, hallucinations, or disorganized speech (APA, 2022)

How School Personnel May Notice (Mueser & Gingerich, 2013) 

Positive Symptoms

Hallucinations, delusions, disorganized speech

Teachers may hear bizarre statements, observe talking to self, paranoia; Nurses may receive complaints of “hearing voices”

Negative Symptoms

Lack of motivation, flat affect, social withdrawal

Coaches may see loss of interest in sports, fatigue; Teachers may see poor academic performance, lack of participation

Cognitive Symptoms

Trouble concentrating, memory issues

Counselors/teachers may notice difficulty following instructions or completing tasks

What to Do if You Suspect Schizophrenia in a Student (Mueser & Gingerich, 2013)

If a Student Discloses (Direct Outcry):

• Remain calm, nonjudgmental, and supportive.

• Avoid challenging their beliefs or hallucinations; instead, validate feelings and express concern.

• Say: “Thank you for telling me. You’re not in trouble. Let’s get someone to help you.”

 If a Staff Member Notices Concerning Behavior:

• Document what you observe: behavior, dates, changes.

• Share concerns with the school counselor, school psychologist, or designated mental health professional.

• Do not attempt to diagnose or label.

If a Third Party (Peer/Parent) Shares Concerns:

• Listen supportively and thank them.

• Share concerns with the appropriate mental health professional or school leadership (Mueser & Gingerich, 2013).

Emergency Response (If Risk of Harm is Present):

• Contact the school crisis team immediately.

• Stay with the student if there are signs of suicidality, psychosis, or danger.

• Call 911 if needed, following your school’s emergency protocol.

Role of the Licensed Professional Counselor (LPC) 

As an LPC in private practice with the appropriate training:

1. Comprehensive Assessment: (NAMI, 2023)

   • Use clinical interview, behavior observation, and standardized tools such as:

     • Structured Clinical Interview for DSM (SCID)

     • Positive and Negative Syndrome Scale (PANSS)

2. Screening for Co-occurring Conditions:

   • Assess for depression, anxiety, substance use, trauma

3. Developing a Treatment Plan: (Dixon, Holoshitz, & Nossel, 2016)

   • Individualized to include:

     • Cognitive Behavioral Therapy for Psychosis (CBT)

     • Social Skills Training

     • Family Psychoeducation

     • Referral for psychiatric evaluation for possible antipsychotic medication

4. Collaborative Care:

   • Communicate with school staff, psychiatrists, and family

   • Provide psychoeducation to increase understanding and reduce stigma

For additional Information, explore:

Schizophrenia

• Schizophrenia and Related Disorders Alliance of America (SARDAA)
  https://sardaa.org/
   

Education, advocacy, and research for schizophrenia and related psychotic disorders.

• NIMH – Schizophrenia
  https://www.nimh.nih.gov/health/topics/schizophrenia

Definition & Classification

Personality Disorders (PDs) are characterized by enduring patterns of inner experience and behavior that deviate markedly from the expectations of an individual’s culture. These patterns are pervasive, inflexible, and begin in adolescence or early adulthood, leading to distress or impairment in social, occupational, or other important areas (American Psychiatric Association, 2022).

PDs are grouped into three clusters:  (APA, 2022)

Cluster A (Odd/Eccentric)

• Paranoid Personality Disorder: Distrust and suspicion of others; perceives motives as malevolent.

• Schizoid Personality Disorder: Detachment from social relationships; limited emotional expression.

• Schizotypal Personality Disorder: Acute discomfort in close relationships, cognitive distortions, and eccentric behavior.

Cluster B (Dramatic/Emotional/Erratic)

• Antisocial Personality Disorder: Disregard for and violation of others’ rights; deceitfulness; impulsivity.

• Borderline Personality Disorder (BPD): Instability in relationships, self-image, and affect; marked impulsivity.

• Histrionic Personality Disorder: Excessive emotionality and attention seeking.

• Narcissistic Personality Disorder: Grandiosity, need for admiration, and lack of empathy.

Cluster C (Anxious/Fearful)

• Avoidant Personality Disorder: Social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

• Dependent Personality Disorder: Excessive need to be taken care of, leading to submissive and clinging behavior.

• Obsessive-Compulsive Personality Disorder (OCPD): Preoccupation with orderliness, perfectionism, and control.

Signs to Watch For (NIMH, n.d.)

Teachers

Chronic classroom disruptions, black-and-white thinking, extreme reactions to feedback, emotional instability.

Coaches

Intense fear of failure, sensitivity to criticism, attempts to control situations/others, risky behavior (esp. in Cluster B).

Cafeteria Monitors

Food rituals (seen in comorbid eating disorders), isolation, mood shifts, attempts to manipulate peer interactions.

Counselors

Repeated interpersonal conflict, difficulty maintaining relationships, self-harming or risk-taking behaviors (common in BPD or Antisocial PD).

What to Do: Suspicions, Outcries, and Emergencies

🔹 If You Suspect a Student May Have a Personality Disorder:

• Approach with compassion and neutrality. Avoid judgmental language.

• Document specific behaviors, not assumptions (e.g., “Student often leaves class abruptly in distress,” not “Student is manipulative.”)

• Refer to the school counselor, mental health specialist, or Student Support Team (SST).

• Follow your district’s Multi-Tiered Systems of Support (MTSS) or 504/IEP process if applicable.

🔹 If a Student or Peer Shares a Concern (“Outcry”):

• Listen calmly and validate the concern.

• Do not promise confidentiality—explain your role as a mandated reporter.

• Report immediately to the school counselor or crisis team.

• If the concern involves harm to self or others, follow crisis protocol and notify administration or SRO (School Resource Officer) as necessary.

🔹 Emergency Protocols:

• Remain with the student if safety is a concern.

• Activate your school's crisis plan.

• Involve mental health first aid responders or local mobile crisis unit.

• Contact emergency services (911) if a student is actively suicidal, homicidal, or unable to ensure their own safety.
  
  

Counselor's Role: LPC in Private Practice

As a Licensed Professional Counselor (LPC), my role includes: (NIMH, n.d.)

• Conducting a comprehensive biopsychosocial assessment, using tools such as the Millon Clinical Multiaxial Inventory-IV (MCMI-IV) or SCID-5-PD, only if qualified.

• Screening for comorbid conditions (e.g., mood, anxiety, trauma, substance use).

• Collaborating with the client (and family when appropriate) to create an individualized treatment plan, using evidence-based strategies.

• Psychoeducation to reduce stigma and increase self-awareness.
  
  

Example of a Treatment Strategy:

For Borderline Personality Disorder,  use Dialectical Behavior Therapy (DBT)—a highly effective, evidence-based approach designed for emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness (Linehan, 1993).

For additional information, explore:

Personality Disorders

• Cleveland Clinic – Personality Disorders Overview
  https://my.clevelandclinic.org/health/diseases/9743-personality-disorders
  
  Clear breakdowns of types, symptoms, and treatment options.

Definition:
A category of mental health disorders characterized by problems in self-control of emotions and behaviors, often resulting in violation of the rights of others or conflict with societal norms (APA, 2022).

Includes:

• Oppositional Defiant Disorder (ODD)

• Intermittent Explosive Disorder (IED)

• Conduct Disorder (CD)

• Antisocial Personality Disorder (APD, diagnosis in adults)

• Pyromania and Kleptomania

Symptoms:

• Anger/irritability

• Argumentative/defiant behavior

• Aggression toward people/animals

• Property destruction

• Deceitfulness or theft

Licensed Professional Counselor’s Role:

As LPCs, we are ethically responsible for:

Conducting developmentally and culturally appropriate assessments

Using standardized tools (with training) (Gresham & Elliott, 2017) 

Collaborating with schools, families, and interdisciplinary teams 

Adhering to the ACA Code of Ethics (ACA, 2014)

Assessment Tools (Examples): (Kazdin, 2017) 

• DICCD: Child Behavior Checklist (CBCL)

• Conners’ Rating Scale

• Disruptive Behavior Rating Scale (DBRS)

Treatment Planning & Evidence-Based Interventions

DICCD Interventions

• CBT: Targets emotional regulation and cognitive distortions

• Parent-Child Interaction Therapy (PCIT): Improves child behavior through positive parent-child interactions

• Multisystemic Therapy (MST): Wraparound care for youth with severe behavioral issues

• Anger Management Skills Training

Program evaluation and advocacy ensure equity in access and support (Barrio Minton et al., 2021). 

School-Based Collaboration

As an LPC (with a background in school counseling), the role includes:

• Consulting with teachers, administrators, and families

• Providing behavioral supports in classroom settings

• Assisting with referrals for special education evaluations

• Supporting social-emotional learning (SEL) programs

Emphasize trauma-informed and culturally responsive approaches.

Ethical Considerations

According to the ACA Code of Ethics (2014):

Only administer assessments you are trained and qualified to use (E.2.a)

Avoid dual relationships and maintain confidentiality (A.6, B.1)

Seek supervision when working with complex cases (F.2)

Promote autonomy and advocate for least-restrictive, supportive interventions (A.1.c)

For additional information, explore:

Disruptive, Impulse-Control, and Conduct Disorders (DICCD)

• Child Mind Institute – Conduct Disorder
  https://childmind.org/guide/conduct-disorder/
  
  

• NIMH – Disruptive Mood Dysregulation Disorder (DMDD)
  https://www.nimh.nih.gov/health/publications/disruptive-mood-dysregulation-disorder

Definition:
Conditions that typically manifest early in development and are characterized by developmental deficits that cause impairments in social, academic, or occupational functioning (APA, 2022).

Includes:

• Attention-Deficit/Hyperactivity Disorder (ADHD)

• Autism Spectrum Disorder (ASD)

• Intellectual Disabilities

• Specific Learning Disorders

• Motor Disorders (e.g., Tourette’s, Tic disorders)

Symptoms:

• Impaired executive function

• Social and communication deficits

• Developmental delays

• Poor attention, impulsivity, hyperactivity (ADHD)

Licensed Professional Counselor’s Role:

As LPCs, we are ethically responsible for:

• Conducting developmentally and culturally appropriate assessments

• Using standardized tools (with training)

• Collaborating with schools, families, and interdisciplinary teams

• Adhering to the ACA Code of Ethics (ACA, 2014)

 Assessment Tools (Examples):

• Neurodevelopmental Disorders:(Kazdin, 2017) 

  • ADHD: Vanderbilt Assessment Scale, Brown ADD Scales, 

  • ASD: Autism Spectrum Rating Scales (ASRS), ADOS (with referral)

  • IQ/LD: Wechsler Intelligence Scale for Children (WISC-V) in partnership with school psychologists

Treatment Planning & Evidence-Based Interventions

ND Interventions 

ADHD: (Barkley, 2015) 

Behavioral therapy, organization skills training, psychoeducation

Collaboration with medical providers for medication management

ASD: (NIMH, 2023)

Social skills groups, structured play therapy, behavioral interventions (e.g., ABA in collaboration)

Support for emotional regulation (Zones of Regulation, CBT modifications)

Learning Disabilities:

• • Referral for academic accommodations (504 Plan/IEP), psychoeducation, study skills coaching

Counselors must tailor treatments to developmental and cultural contexts while empowering clients and families (ACA, 2014). 

School-Based Collaboration

As an LPC (with a background in school counseling), the role includes:

• Consulting with teachers, administrators, and families

• Providing behavioral supports in classroom settings

• Assisting with referrals for special education evaluations

• Supporting social-emotional learning (SEL) programs

Emphasize trauma-informed and culturally responsive approaches.

Program evaluation and advocacy ensure equity in access and support (Barrio Minton et al., 2021). 

Ethical Considerations

According to the ACA Code of Ethics (2014):

Only administer assessments you are trained and qualified to use (E.2.a)

Avoid dual relationships and maintain confidentiality (A.6, B.1)

Seek supervision when working with complex cases (F.2)

Promote autonomy and advocate for least-restrictive, supportive interventions (A.1.c)

For additional information, explore:

Neurodevelopmental Disorders

• CDC – ADHD
  https://www.cdc.gov/ncbddd/adhd/index.html
  
  

• Autism Speaks – Autism Spectrum Disorder (ASD)
  https://www.autismspeaks.org/what-autism

SAMHSA’s Behavioral Health Treatment Services Locator

🔗 https://findtreatment.samhsa.gov/

• Purpose: Helps counselors, clients, and families locate mental health and substance use treatment facilities across the U.S.

• Use in Counseling: Excellent for referrals when students/clients require specialized or higher-level care (e.g., inpatient, eating disorders, trauma-focused therapy).

• Bonus: Includes filters for age, treatment approach, insurance, and more.

National Child Traumatic Stress Network (NCTSN)

🔗 https://www.nctsn.org/

• Purpose: Provides evidence-based resources and toolkits for professionals working with children and adolescents exposed to trauma.

• Use in Counseling: Offers free downloadable guides, assessment tools, classroom strategies, and caregiver handouts.

• Especially helpful for trauma-informed counseling, prevention strategies, and school-based interventions.
  
  

American School Counselor Association (ASCA) Toolkit

🔗 https://www.schoolcounselor.org/

• Purpose: ASCA provides research-backed strategies for prevention, intervention, and student support, especially within K–12 settings.

• Use in Counseling: Access frameworks, ethical guidelines, referral processes, and mental health support strategies for students.

• Also includes: Crisis response guides, college/career readiness tools, and resources for working with diverse populations.
  
  

Mental Health America (MHA) – For Mental Health Providers

🔗 https://www.mhanational.org/mental-health-providers

• Purpose: Offers a variety of screening tools, referral resources, and evidence-based strategies for clinicians.

• Use in Counseling: Ideal for initial screening, client education, and guidance on best practices for treatment planning.

• Bonus: Access to toolkits for specific populations, including BIPOC, LGBTQ+, youth, and veterans.

Child Mind Institute – Resources for Educators and Clinicians

🔗 https://childmind.org/

• Purpose: Provides articles, guides, and toolkits written by clinicians for school personnel and mental health providers.

• Use in Counseling: Excellent for identifying behavioral/emotional issues in students, guiding referrals, and developing support plans.

• Especially strong for ADHD, anxiety, trauma, and learning differences.

The Trevor Project – Crisis Intervention and Referral Support for LGBTQ+ Youth

🔗 https://www.thetrevorproject.org/resources/

• Purpose: Offers free mental health crisis support, education materials, and referral guides specific to LGBTQ+ youth.

• Use in Counseling: Refer students in need, access resources for family education, and utilize tools for affirming mental health practices.

• Includes a 24/7 crisis line, text line, and chat for emergency support.

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