Conditions We Treat

ADHD isn't a failure of effort or willpower. It's a difference in how the brain regulates attention — and it often goes unrecognized for years, especially in adults.

Most people who come to us with ADHD have already spent years being told some version of the same thing: try harder, stay focused, just get organized. By the time they arrive, they've often internalized the message that the problem is character, not neurology.

It isn't.

ADHD is a condition that affects how the brain regulates attention, impulse, and executive function. It doesn't mean someone is lazy or careless. It often means they're working significantly harder than everyone around them just to keep up — and exhausting themselves in the process.

ADHD looks different across different people. In children, it often shows up as difficulty sitting still, impulsivity, or trouble completing tasks. In adults, it's frequently subtler — chronic disorganization, difficulty sustaining effort on things that don't hold interest, emotional reactivity, and a persistent sense of underachievement despite real ability. In women and girls, it's often missed entirely, presenting more as inattentiveness and internal restlessness than outward hyperactivity.

Evaluation matters here. A careful assessment looks at the full picture — when symptoms started, how they show up across different settings, what else might be contributing. Anxiety, depression, sleep problems, and learning differences can all look like ADHD, or co-occur with it. Getting it right means taking the time to understand the whole person, not just the checklist.

Treatment is often a combination of medication and practical support. Stimulant medications are among the most well-studied in psychiatry — when they're right, they're often noticeably effective. But medication isn't the whole answer. Understanding how your brain works, and building structures around it rather than against it, is part of what makes treatment stick.

If you've spent years wondering why things feel harder for you than they seem to be for others, it's worth finding out why.

Autism describes a different way of experiencing the world — not a defective one. Many people don't receive an accurate diagnosis until adulthood, often after years of not understanding why things felt so hard.

Autism is still widely misunderstood — both in the culture and, sometimes, in clinical settings. The image most people carry is narrow and often inaccurate. Many autistic people don't fit that image at all.

What autism actually describes is a different way of processing the social and sensory world. People on the spectrum often notice things others miss, think in patterns and systems, and communicate in ways that are direct and precise. These aren't deficits. They're differences — and in the right environments, real strengths.

The challenges are real too. Social situations can be genuinely exhausting when they require constant translation — reading unspoken rules, managing sensory overload, navigating a world that wasn't designed with your nervous system in mind. Anxiety is extremely common. So is burnout, particularly in people who have spent years masking — suppressing their natural responses to fit in — without ever getting the support they needed.

Many people reach a diagnosis in adulthood, sometimes after years of feeling like something was fundamentally wrong with them. A late diagnosis often brings relief alongside grief — relief at finally having language for an experience that felt isolating and confusing, and grief for the years spent without it.

Evaluation at North Star is thorough and unhurried. We're not looking to confirm a stereotype. We're trying to understand how you experience the world, where the friction is, and what kind of support would actually help.

Treatment isn't about changing who you are. It's about reducing unnecessary suffering, building skills where they're wanted, and creating conditions where you can function in ways that feel sustainable.

Depression doesn't always look like sadness. It can look like flatness, exhaustion, or disconnection — and it often lies to the people who have it, telling them nothing will help. That isn't true.

Depression doesn't always look the way people expect. It isn't always crying or visible sadness. Sometimes it looks like flatness — a kind of muted, low-grade disconnection from things that used to matter. Sometimes it's exhaustion that sleep doesn't fix. Irritability. Difficulty concentrating. A sense that pleasure has gone quiet.

Whatever it looks like, depression is serious — and it's treatable.

One of the most important things we've come to understand is that depression often tells people lies about itself. It says things like: this is just who I am, nothing will help, I don't deserve to feel better. Those thoughts feel true from inside the depression. They're not.

Treatment depends on what's driving the depression and what's sustaining it. Sometimes medication is the right starting point — particularly when depression is severe enough to make therapy difficult to engage with. Sometimes therapy is primary, helping someone understand the patterns and losses underneath the mood. Often both together work better than either alone.

Depression that hasn't responded to previous treatment is a particular focus at North Star. If you've tried medications that haven't worked, or feel like you've been through treatment without real relief, that's a clinical problem worth taking seriously — not evidence that you're a lost cause. It usually means something important hasn't been understood or addressed yet.

Getting better from depression is possible. It usually takes longer than people want it to, and requires more patience than feels fair. But it's possible.

Anxiety is the most common reason people seek psychiatric care — and one of the most commonly undertreated. Many people have lived with it so long they've mistaken it for personality. It isn't.

Anxiety is the most common reason people seek psychiatric care — and one of the most commonly undertreated, because it's easy to mistake the patterns of anxiety for personality, or just the way things are.

Anxiety isn't weakness. It's a nervous system that has learned — often for good historical reasons — to treat a wide range of situations as dangerous. The alarm system is working. It's just miscalibrated.

One thing worth saying clearly: many people are reluctant to treat their anxiety because they believe it gives them an edge — that the worry is what keeps them sharp, prepared, on top of things. This is a common and understandable belief. It's also not supported by evidence. Chronic anxiety doesn't improve performance. It degrades it. It consumes cognitive resources, narrows thinking, and drains the energy needed to do difficult things well. Treating anxiety doesn't make someone less driven or less careful. It frees up capacity that anxiety was quietly consuming.

It shows up differently in different people. Some people experience it as persistent worry — a running background loop of what ifs that's hard to turn off. Others feel it more physically: tightness in the chest, difficulty breathing, a persistent sense of dread. Panic attacks — sudden waves of intense fear with physical symptoms — can be terrifying and are frequently misunderstood as medical emergencies by the people having them.

Social anxiety, which can range from mild discomfort in groups to significant avoidance of ordinary situations, is particularly underrecognized. Many people with social anxiety have simply organized their life around avoiding the things that trigger it, without realizing that avoidance is part of what keeps anxiety going.

Treatment for anxiety is effective. Therapy — particularly approaches that involve gradually reducing avoidance rather than working around it — is often the most durable intervention. Medication can reduce the intensity of symptoms significantly, making therapy easier to engage with and life more livable in the meantime.

The goal isn't the absence of anxiety. It's an anxiety that no longer runs your life.

OCD is one of the most painful conditions in psychiatry — and one of the most misrepresented. Most people who have it suffer in silence for years before anyone gets it right.

OCD is one of the most misrepresented conditions in psychiatry — and one of the most painful to live with. The cultural image — someone who likes things clean and organized, who double-checks the stove — doesn't capture what OCD actually is for most people who have it. What it captures even less is the suffering. OCD can be relentless, exhausting, and profoundly isolating. People often describe it as a form of mental torture — intrusive, unwanted, and impossible to simply stop.

OCD is characterized by intrusive thoughts, images, or urges (obsessions) that feel disturbing and uncontrollable, followed by compulsive behaviors or mental rituals aimed at reducing the distress they cause. The content of obsessions is often the opposite of what a person actually wants — thoughts about harm, contamination, sexuality, religion, or making terrible mistakes. The fact that the thoughts feel so foreign and disturbing is part of what makes OCD so hard to live with. And it's one of the things that distinguishes OCD from actually wanting to act on the thoughts.

People with OCD often spend years in shame before telling anyone. The content of the obsessions feels unspeakable. The rituals feel embarrassing. Many people have seen therapists or psychiatrists without the OCD being correctly identified — because they couldn't bring themselves to say exactly what the thoughts were, or because the clinician didn't ask.

Getting it right matters, because OCD has a specific, highly effective treatment: Exposure and Response Prevention (ERP), a form of therapy that involves gradually confronting feared thoughts and situations without performing the rituals that temporarily relieve them. Medication — particularly SSRIs at therapeutic doses — is also an important part of treatment for many people.

If you've been struggling with thoughts you can't get out of your head, or rituals you feel compelled to perform despite knowing they don't make logical sense, it's worth talking to someone who understands OCD well. There is effective treatment. It's not about controlling the thoughts. It's about changing your relationship to them.

Bipolar disorder is frequently misdiagnosed — sometimes for years — because the elevated periods often don't feel like illness. Understanding the full pattern is what makes treatment work.

Bipolar disorder is frequently misdiagnosed — sometimes for years — and just as frequently misunderstood by the people who have it. The condition involves episodes of depression and episodes of elevated or expansive mood (mania or hypomania), but the picture is rarely as clean as the textbook description.

Depression is usually what brings people in. The elevated periods — especially in bipolar II, where they're less extreme — often don't feel like illness. They can feel like finally functioning, finally having energy, finally being productive. It's the depression that's unbearable. The highs can seem like relief.

This creates a diagnostic problem. If someone comes in depressed, and doesn't mention or recognize the elevated periods, they may be treated for unipolar depression — sometimes for years — without adequate results. Antidepressants used without mood stabilizers can destabilize bipolar disorder rather than treat it.

Careful evaluation is essential. This means asking about the full history of someone's mood — not just the current episode — and taking seriously a family history of mood disorders, past periods of unusual energy or decreased need for sleep, and patterns of treatment response.

Treatment for bipolar disorder is effective, but it requires precision and patience. Mood stabilizers and certain other medications are the foundation of treatment. Therapy plays an important role in helping people recognize early warning signs, build routines that support stability, and navigate the real relational and occupational challenges that come with the condition.

Living well with bipolar disorder is possible. It requires understanding your own pattern more clearly than most people are asked to understand themselves.

Personality disorders are among the most stigmatized diagnoses in psychiatry — and among the most frequently misapplied. They describe real suffering, not difficult people. Effective treatment exists.

Personality disorders are among the most stigmatized diagnoses in psychiatry — and among the most frequently misused. They've been applied dismissively, as explanations for why someone is difficult rather than as clinical descriptions of real suffering. That history has done a lot of harm.

What personality disorders actually describe are enduring patterns of experiencing and relating to the world that cause significant distress or difficulty — for the person who has them, for their relationships, or both. These patterns usually develop early, often in response to environments where different ways of being weren't safe or available. They made sense once. They often create problems now.

The most commonly discussed is borderline personality disorder (BPD), characterized by intense emotional responses, fear of abandonment, unstable relationships, and a sometimes fragmented sense of self. People with BPD often describe feeling things more intensely than others, and being slower to return to baseline once activated. This isn't manipulation or attention-seeking — it's a nervous system that learned to operate at a different threshold.

Other personality presentations — obsessive, avoidant, narcissistic, dependent — reflect different patterns with their own histories and their own costs.

Treatment works. Dialectical Behavior Therapy (DBT) has strong evidence for BPD and related presentations. Other structured approaches, including longer-term psychodynamic therapy, help people understand where patterns come from and find more flexibility in how they respond.

People with personality disorders often arrive having been told — explicitly or implicitly — that they're too much, untreatable, or responsible for their own suffering in a way that closes off help. That framing is both clinically inaccurate and harmful. Effective care is possible. It takes time. It requires a clinician who isn't frightened of the intensity. And it can change things in lasting ways.

Psychosis is among the most frightening experiences a person can go through — and among the most misunderstood. It is a symptom, not an identity, and it responds to treatment.

Psychosis — experiences that involve a break from shared reality — is among the most frightening things a person can go through, both for the person experiencing it and for the people around them. It's also among the most misunderstood.

Psychosis isn't the same as violence. It isn't the same as permanent incapacity. It isn't a character flaw or a sign of who someone fundamentally is. It's a symptom — one that can occur in several different conditions, and one that responds to treatment.

It can involve hearing or seeing things others don't, holding beliefs that feel absolutely certain but aren't grounded in shared reality, or experiencing profound disorganization in thinking and perception. It can arrive gradually or suddenly. It can be terrifying or, in some states, feel strangely calm. The person experiencing it often doesn't recognize it as illness — the experiences feel real, because in some sense, to them, they are.

Psychosis occurs in conditions including schizophrenia, schizoaffective disorder, and severe episodes of bipolar disorder or depression. It can also be triggered by substances, medical conditions, or extreme sleep deprivation. Understanding what's driving it matters for how it's treated.

Early intervention matters enormously. The longer a psychotic episode goes untreated, the harder recovery tends to be. Antipsychotic medications are the primary treatment and are often effective in reducing or eliminating symptoms. Therapy — particularly certain structured approaches — is an important part of long-term recovery and relapse prevention.

If someone you love is experiencing something that seems like a break from reality, getting an evaluation quickly is important. If you're reading this because you've had experiences you haven't been able to explain or talk about, that took courage. It's worth speaking to someone who can help make sense of what's been happening.

Care is possible. Recovery is real.

Eating disorders are among the most serious psychiatric conditions — and among the most isolating. The suffering is rarely visible. We see the person struggling, and we see the people who love them.

Eating disorders affect how someone relates to food, their body, and often to themselves in fundamental ways. Anorexia, bulimia, binge eating disorder, and related presentations differ in how they show up — but they share a common thread: the disorder becomes a way of managing something that feels otherwise unmanageable. Understanding what that is, for a particular person, is where treatment begins.

These conditions require coordinated care. A psychiatrist alone is not the right treatment for an eating disorder. Effective care typically involves a therapist with specific eating disorder expertise, a dietitian, a medical provider monitoring physical health, and often family support — working together rather than in parallel. Our role is to function as one node in that network: providing psychiatric evaluation, medication management when appropriate, and ongoing communication with the rest of the treatment team.

For families, we want to say this directly: watching someone you love struggle with an eating disorder is its own kind of suffering. The fear of saying the wrong thing, the helplessness of watching meals become battlegrounds, the exhaustion of not knowing how to help — these are real, and they matter. Supporting a family member through an eating disorder is not a peripheral concern. It's part of the clinical picture.

If you or someone you love is struggling, the first step is an evaluation. We'll be clear about what level of care is appropriate, who else needs to be involved, and what the path forward looks like — honestly, without minimizing how hard this is.