What are the symptoms of OCD?

Contamination obsessions; Harm obsessions; Symmetry and ordering; Checking compulsions; Mental rituals; Hoarding

Exposure and Response Prevention (ERP) — gold-standard psychotherapy for OCD; SSRIs at higher doses than used for depression (fluoxetine, fluvoxamine, sertraline); Clomipramine (tricyclic antidepressant) for treatment-resistant OCD; Acceptance and Commitment Therapy (ACT); Psychoeducation about the OCD cycle; Family therapy to reduce accommodation behaviors

Can I get treatment for OCD via telehealth in North Carolina?

Yes. Wellness Behavioral Health and Healing PLLC offers telehealth psychiatric care for OCD statewide across North Carolina. Board-certified PMHNP-BC Zoe Karpee provides evidence-based evaluation, diagnosis, and medication management via secure video appointments.

DSM-5 · F90.0–F90.9

ADHD

Attention-Deficit/Hyperactivity Disorder affects focus, impulse control, and daily functioning in children and adults.

DSM-5 Clinical Definition

"A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development."

ADHD is one of the most common neurodevelopmental disorders, affecting approximately 5–10% of children and 2–5% of adults worldwide. It is characterized by persistent patterns of inattention, hyperactivity, and impulsivity that significantly impair daily functioning at home, school, or work. ADHD is not a character flaw — it is a brain-based condition with strong genetic components that responds well to evidence-based treatment.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Inattention

Difficulty sustaining focus, frequent careless mistakes, easily distracted, forgetfulness in daily activities.

Hyperactivity

Excessive fidgeting, inability to remain seated, running or climbing in inappropriate situations, talking excessively.

Impulsivity

Blurting out answers, difficulty waiting turns, interrupting others, making hasty decisions without considering consequences.

Disorganization

Difficulty organizing tasks, losing items, poor time management and planning skills.

Emotional dysregulation

Low frustration tolerance, mood swings, difficulty managing stress, heightened emotional reactions.

Working memory deficits

Difficulty holding information in mind while completing tasks, forgetting instructions mid-task.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Stimulant medications (methylphenidate, amphetamine salts) — first-line pharmacotherapy

Non-stimulant medications (atomoxetine, guanfacine, bupropion)

Cognitive Behavioral Therapy (CBT) targeting executive function

Behavioral parent training for children with ADHD

Psychoeducation for patients and families

Mindfulness-based interventions to improve attention regulation

When to Seek Help

Seek a psychiatric evaluation if ADHD symptoms have been present since childhood, occur in multiple settings (home, work, school), and cause significant impairment in daily functioning. Adults who were never diagnosed as children but recognize lifelong patterns of inattention should also seek evaluation.

Related conditions we treat

Anxiety Disorders Depression Mood Disorders Sleep Disorders

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

Woman sitting alone looking worried, representing anxiety disorder

DSM-5 · F40–F41

Anxiety Disorders

Anxiety disorders are the most common mental health conditions worldwide, causing persistent fear and worry that disrupts daily life.

DSM-5 Clinical Definition

"Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities."

Anxiety disorders encompass a group of conditions — including Generalized Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, and specific phobias — characterized by excessive, persistent fear or worry that is difficult to control and causes significant distress or functional impairment. Anxiety is the most prevalent mental health condition in the United States, affecting over 40 million adults annually.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Excessive worry

Persistent, uncontrollable worry about multiple areas of life disproportionate to actual risk.

Physical tension

Muscle tension, headaches, fatigue, restlessness, and feeling keyed up or on edge.

Panic attacks

Sudden surges of intense fear with racing heart, shortness of breath, chest tightness, dizziness.

Avoidance behavior

Avoiding situations that trigger anxiety, leading to progressive restriction of daily life.

Sleep disturbance

Difficulty falling or staying asleep due to racing thoughts or physical tension.

Concentration difficulties

Mind going blank, difficulty focusing, easily distracted by anxious thoughts.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Selective Serotonin Reuptake Inhibitors (SSRIs) — first-line pharmacotherapy

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Buspirone for generalized anxiety

Cognitive Behavioral Therapy (CBT) with exposure techniques

Mindfulness-Based Stress Reduction (MBSR)

Relaxation techniques and breathing retraining

When to Seek Help

Seek help when anxiety interferes with work, relationships, or daily activities; when you avoid situations due to fear; when physical symptoms of anxiety are frequent; or when worry feels uncontrollable despite your best efforts to manage it.

Related conditions we treat

Depression PTSD & Trauma OCD Sleep Disorders

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

DSM-5 · F32–F33

Depression

Major Depressive Disorder is a leading cause of disability worldwide, affecting mood, energy, and the ability to experience pleasure.

DSM-5 Clinical Definition

"Depressed mood or loss of interest or pleasure in nearly all activities, present for most of the day, nearly every day, for at least two weeks."

Depression (Major Depressive Disorder) is a serious medical condition that affects how a person feels, thinks, and handles daily activities. It is not simply sadness or a sign of weakness — it is a complex brain disorder involving changes in neurotransmitter systems, stress hormones, and neural circuitry. Depression affects over 280 million people globally and is the leading cause of disability worldwide. With proper treatment, the vast majority of people with depression experience significant improvement.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Persistent low mood

Feeling sad, empty, hopeless, or tearful most of the day, nearly every day.

Loss of interest

Markedly diminished interest or pleasure in activities once enjoyed, including hobbies, socializing, and sex.

Fatigue and low energy

Persistent tiredness, physical slowing, and lack of motivation even after adequate rest.

Cognitive changes

Difficulty concentrating, making decisions, or remembering things; slowed thinking.

Sleep changes

Insomnia (difficulty falling or staying asleep) or hypersomnia (sleeping too much).

Thoughts of death

Recurrent thoughts of death or suicide, or a suicide attempt. Seek emergency care immediately if present.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Antidepressant medications (SSRIs, SNRIs, bupropion, mirtazapine)

Augmentation strategies for treatment-resistant depression

Cognitive Behavioral Therapy (CBT)

Interpersonal Therapy (IPT)

Behavioral Activation therapy

Lifestyle interventions: exercise, sleep hygiene, nutrition

When to Seek Help

Seek help if depressive symptoms have persisted for two weeks or more, are interfering with work or relationships, or if you are having any thoughts of self-harm or suicide. Depression is highly treatable — early intervention leads to better outcomes.

Related conditions we treat

Anxiety Disorders Bipolar Disorder Sleep Disorders Women's Mental Health

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

DSM-5 · F31

Bipolar Disorder

Bipolar disorder causes dramatic shifts in mood, energy, and activity levels — from manic highs to depressive lows.

DSM-5 Clinical Definition

"Defined by the occurrence of one or more manic episodes, often accompanied by hypomanic or major depressive episodes."

Bipolar disorder is a chronic mood disorder characterized by episodes of mania or hypomania alternating with episodes of depression. There are several types: Bipolar I (full manic episodes), Bipolar II (hypomanic episodes with major depression), and Cyclothymic Disorder (milder cycling). It affects approximately 2.8% of U.S. adults and requires long-term psychiatric management. With proper treatment, most people with bipolar disorder can lead stable, fulfilling lives.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Manic episodes

Abnormally elevated or irritable mood, decreased need for sleep, grandiosity, racing thoughts, increased goal-directed activity, risky behavior.

Depressive episodes

Persistent low mood, loss of interest, fatigue, hopelessness, difficulty concentrating, thoughts of death.

Hypomanic episodes

Similar to mania but less severe and shorter in duration; does not cause marked impairment or require hospitalization.

Rapid cycling

Four or more mood episodes (manic, hypomanic, or depressive) within a 12-month period.

Mixed features

Simultaneous symptoms of both mania and depression — feeling energized yet hopeless or suicidal.

Psychotic features

In severe mania or depression: hallucinations, delusions, or disorganized thinking.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Mood stabilizers (lithium, valproate, lamotrigine) — cornerstone of treatment

Atypical antipsychotics (quetiapine, aripiprazole, lurasidone)

Psychoeducation about mood cycling and early warning signs

Cognitive Behavioral Therapy (CBT) adapted for bipolar disorder

Interpersonal and Social Rhythm Therapy (IPSRT)

Regular sleep and routine maintenance

When to Seek Help

Seek psychiatric evaluation if you experience periods of unusually elevated mood, decreased need for sleep, impulsive behavior, or grandiosity — especially if alternating with depressive episodes. Early diagnosis and mood stabilization prevent long-term complications.

Related conditions we treat

Anxiety Disorders Depression Mood Disorders Sleep Disorders

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

Woman with distant gaze representing PTSD and trauma

DSM-5 · F43.1

PTSD & Trauma

Post-Traumatic Stress Disorder develops after exposure to traumatic events and causes lasting changes in how the brain processes fear and memory.

DSM-5 Clinical Definition

"Exposure to actual or threatened death, serious injury, or sexual violence, followed by intrusion symptoms, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity."

PTSD is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, serious accident, terrorist act, war/combat, rape, or other violent personal assault. PTSD affects approximately 3.5% of U.S. adults each year. It is not a sign of weakness — it is a normal brain response to abnormal events. Effective treatments exist that can significantly reduce symptoms and restore quality of life.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Intrusive memories

Recurrent, involuntary distressing memories, flashbacks, or nightmares of the traumatic event.

Avoidance

Avoiding thoughts, feelings, people, places, or activities that trigger memories of the trauma.

Negative cognitions

Persistent negative beliefs about oneself or the world, distorted blame, persistent negative emotions (fear, horror, guilt, shame).

Hyperarousal

Hypervigilance, exaggerated startle response, sleep disturbance, irritability, angry outbursts, difficulty concentrating.

Emotional numbing

Feeling detached from others, inability to experience positive emotions, sense of a foreshortened future.

Dissociation

Feeling detached from one's own mind or body, or as if the world is unreal (depersonalization/derealization).

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

EMDR (Eye Movement Desensitization and Reprocessing)

Prolonged Exposure (PE) therapy

Cognitive Processing Therapy (CPT)

SSRIs/SNRIs for PTSD symptom management (sertraline, paroxetine, venlafaxine)

Prazosin for trauma-related nightmares

When to Seek Help

Seek help if trauma symptoms have persisted for more than one month, are causing significant distress, or are interfering with daily functioning. You do not need to have experienced combat or a single dramatic event — any traumatic experience can cause PTSD.

Related conditions we treat

Anxiety Disorders Depression Sleep Disorders Substance Use Disorders

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

DSM-5 · F30–F39

Mood Disorders

Mood disorders cause significant disruptions in emotional state, affecting energy, behavior, and the ability to function in daily life.

DSM-5 Clinical Definition

"A category of illnesses that affect a person's persistent emotional state, including depressive disorders, bipolar disorders, and related conditions."

Mood disorders are a broad category of psychiatric conditions that primarily affect a person's emotional state. They include Major Depressive Disorder, Persistent Depressive Disorder (Dysthymia), Bipolar I and II Disorders, Cyclothymic Disorder, Premenstrual Dysphoric Disorder (PMDD), and mood disorders due to medical conditions or substances. Mood disorders affect approximately 21% of U.S. adults at some point in their lives and are among the leading causes of disability worldwide.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Persistent sadness or emptiness

Prolonged low mood lasting weeks or months, not explained by life circumstances alone.

Irritability

Heightened irritability, frustration, or anger that is disproportionate to situations, especially in children and adolescents.

Energy changes

Significant fatigue and low energy, or conversely, periods of unusually high energy and decreased need for sleep.

Anhedonia

Loss of interest or pleasure in activities previously enjoyed, including hobbies, socializing, and relationships.

Cognitive impairment

Difficulty concentrating, making decisions, or remembering things; slowed thinking.

Somatic complaints

Unexplained physical symptoms such as headaches, digestive problems, or chronic pain associated with mood changes.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Antidepressants (SSRIs, SNRIs, bupropion, mirtazapine)

Mood stabilizers for bipolar spectrum disorders

Cognitive Behavioral Therapy (CBT)

Dialectical Behavior Therapy (DBT) for emotional dysregulation

Interpersonal Therapy (IPT)

Lifestyle interventions: exercise, sleep regulation, stress management

When to Seek Help

Seek evaluation when mood changes are persistent (lasting weeks), interfere with daily functioning, or cause significant distress. Early treatment of mood disorders prevents progression and improves long-term outcomes.

Related conditions we treat

Anxiety Disorders Depression Bipolar Disorder Women's Mental Health

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

DSM-5 · F51

Sleep Disorders

Sleep disorders disrupt the quality, timing, and amount of sleep, leading to daytime distress and impaired functioning.

DSM-5 Clinical Definition

"Dissatisfaction with sleep quantity or quality, associated with difficulty initiating sleep, maintaining sleep, or early-morning awakening with inability to return to sleep."

Sleep disorders encompass a range of conditions including Insomnia Disorder, Hypersomnolence Disorder, Narcolepsy, Circadian Rhythm Sleep-Wake Disorders, and Parasomnias. Insomnia is the most common, affecting approximately 10–30% of adults. Sleep disorders are closely linked to psychiatric conditions — they can both cause and worsen depression, anxiety, ADHD, and bipolar disorder. Addressing sleep is often a critical component of comprehensive mental health treatment.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Difficulty falling asleep

Lying awake for 30 minutes or more before falling asleep, despite feeling tired.

Frequent night waking

Waking up multiple times during the night and having difficulty returning to sleep.

Early morning awakening

Waking up significantly earlier than desired and being unable to fall back asleep.

Non-restorative sleep

Waking up feeling unrefreshed despite adequate time in bed; persistent daytime fatigue.

Daytime impairment

Fatigue, mood disturbance, difficulty concentrating, reduced motivation, or increased errors at work or school.

Sleep-related anxiety

Worry about sleep itself, clock-watching, and performance anxiety around bedtime that perpetuates insomnia.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Cognitive Behavioral Therapy for Insomnia (CBT-I) — first-line treatment

Sleep restriction therapy and stimulus control

Sleep hygiene education and circadian rhythm optimization

Short-term sleep medications (trazodone, mirtazapine, low-dose doxepin)

Melatonin receptor agonists (ramelteon) for circadian disorders

Treatment of underlying psychiatric conditions contributing to sleep disruption

When to Seek Help

Seek help when sleep problems occur at least 3 nights per week for 3 months or more, cause significant daytime impairment, or are not explained by another medical condition. Poor sleep significantly worsens all mental health conditions.

Related conditions we treat

ADHD Anxiety Disorders Depression Bipolar Disorder

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

Young woman with conflicted expression representing eating disorder recovery

DSM-5 · F50

Eating Disorders

Eating disorders are serious mental health conditions involving persistent disturbances in eating behavior and related thoughts and emotions.

DSM-5 Clinical Definition

"Persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning."

Eating disorders — including Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder, and Avoidant/Restrictive Food Intake Disorder (ARFID) — are serious, potentially life-threatening conditions affecting approximately 9% of the U.S. population. They have the highest mortality rate of any psychiatric disorder. Eating disorders are not lifestyle choices — they are complex biopsychosocial conditions requiring specialized, multidisciplinary treatment.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Restrictive eating

Severely limiting food intake, skipping meals, eliminating entire food groups, or eating only 'safe' foods.

Binge eating

Eating large amounts of food in a short period with a sense of loss of control, often followed by guilt or shame.

Purging behaviors

Self-induced vomiting, misuse of laxatives or diuretics, or excessive exercise to compensate for eating.

Body image distortion

Intense fear of weight gain, distorted perception of body size or shape, self-worth tied to weight or appearance.

Physical complications

Electrolyte imbalances, dental erosion, hair loss, amenorrhea, fatigue, fainting, or heart arrhythmias.

Social withdrawal

Avoiding meals with others, hiding eating behaviors, withdrawing from social activities involving food.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Psychiatric evaluation and medical stabilization

SSRIs for bulimia nervosa and binge-eating disorder

Cognitive Behavioral Therapy (CBT) for eating disorders

Dialectical Behavior Therapy (DBT) for emotional regulation

Family-Based Treatment (FBT/Maudsley approach) for adolescents

Nutritional counseling and medical monitoring

When to Seek Help

Seek help immediately if eating behaviors are causing physical health complications, significant weight loss, or thoughts of self-harm. Eating disorders are most treatable when caught early — do not wait for the condition to become 'severe enough.'

Related conditions we treat

Anxiety Disorders Depression OCD Women's Mental Health

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

Man sitting alone looking hopeful representing substance use recovery

DSM-5 · F10–F19

Substance Use Disorders

Substance use disorders involve compulsive use of substances despite harmful consequences, driven by changes in brain chemistry.

DSM-5 Clinical Definition

"A cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems."

Substance Use Disorders (SUDs) involve a pattern of using alcohol, prescription medications, or illicit drugs that causes significant impairment or distress. They are characterized by loss of control over use, continued use despite negative consequences, and physiological changes including tolerance and withdrawal. SUDs affect approximately 20 million Americans annually and are highly co-occurring with other psychiatric conditions including depression, anxiety, PTSD, and ADHD.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Loss of control

Using more of a substance than intended, or for longer than planned, despite attempts to cut back.

Craving

Strong urge or compulsion to use the substance that is difficult to resist.

Tolerance

Needing increasingly larger amounts of the substance to achieve the same effect.

Withdrawal

Physical or psychological symptoms when the substance is reduced or stopped (varies by substance).

Neglect of responsibilities

Failing to fulfill obligations at work, school, or home due to substance use.

Continued use despite harm

Persisting in use despite awareness of physical, psychological, social, or legal consequences.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Medication-Assisted Treatment (MAT): buprenorphine/naloxone for opioid use disorder

Naltrexone for alcohol and opioid use disorders

Acamprosate and disulfiram for alcohol use disorder

Motivational Interviewing (MI)

Cognitive Behavioral Therapy (CBT) for relapse prevention

Dual diagnosis treatment for co-occurring psychiatric conditions

When to Seek Help

Seek help when substance use is causing problems in any area of life — health, relationships, work, finances, or legal issues. Addiction is a medical condition, not a moral failing. Medication-assisted treatment is highly effective and can be started quickly.

Related conditions we treat

ADHD Anxiety Disorders Depression PTSD & Trauma

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

Father and daughter together representing child and adolescent mental health support

DSM-5 · F90–F98

Child & Adolescent Psychiatry

Mental health conditions in children and adolescents require specialized evaluation and age-appropriate treatment approaches.

DSM-5 Clinical Definition

"Mental disorders in children and adolescents are characterized by clinically significant disturbances in cognition, emotional regulation, or behavior that reflect dysfunction in the psychological, biological, or developmental processes underlying mental functioning."

Child and adolescent psychiatry addresses the unique mental health needs of individuals from infancy through young adulthood. Common conditions include ADHD, anxiety disorders, depression, autism spectrum disorder, oppositional defiant disorder, conduct disorder, and early-onset psychosis. Early identification and treatment of mental health conditions in youth is critical — 50% of all lifetime mental health conditions begin by age 14, and 75% by age 24.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Behavioral changes

Sudden changes in behavior, increased aggression, defiance, or withdrawal from family and friends.

Academic decline

Significant drop in grades, refusal to attend school, or inability to concentrate in class.

Mood disturbances

Persistent sadness, irritability, excessive worry, or emotional outbursts disproportionate to situations.

Social withdrawal

Pulling away from friends, loss of interest in activities, preferring isolation.

Physical complaints

Frequent unexplained headaches, stomachaches, or fatigue — often a somatic expression of emotional distress.

Self-harm or suicidal ideation

Any mention of wanting to die, self-harm behaviors, or giving away possessions requires immediate evaluation.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Comprehensive psychiatric evaluation including developmental history

Age-appropriate psychotherapy (CBT, play therapy, DBT for teens)

Medication management when indicated (stimulants, SSRIs, mood stabilizers)

Parent training and family therapy

School consultation and IEP/504 planning support

Coordination with pediatricians and school counselors

When to Seek Help

Seek evaluation if your child's emotional or behavioral symptoms have persisted for more than 2–4 weeks, are causing significant distress, or are interfering with school, friendships, or family life. Trust your instincts as a parent — early intervention makes a significant difference.

Related conditions we treat

ADHD Anxiety Disorders Depression Mood Disorders

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

Therapist and patient in a counseling session representing individual therapy

DSM-5 · Z00–Z99

Individual & Group Counseling

Therapy provides a safe, structured space to explore thoughts, emotions, and behaviors — and develop skills for lasting change.

DSM-5 Clinical Definition

"Psychotherapy encompasses a range of treatments that help people with mental health problems, emotional challenges, and some psychiatric disorders."

Individual and group counseling are evidence-based therapeutic modalities used to treat a wide range of mental health conditions. Individual therapy provides one-on-one support tailored to personal goals, while group therapy offers peer connection, shared experience, and social skill development. Therapy is often used alongside psychiatric medication management for optimal outcomes. Common approaches include CBT, DBT, ACT, psychodynamic therapy, and trauma-focused therapies.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Persistent emotional distress

Ongoing feelings of sadness, anxiety, anger, or emptiness that interfere with daily life.

Relationship difficulties

Recurring conflicts, communication problems, or patterns of unhealthy relationships.

Trauma history

Past traumatic experiences that continue to affect current thoughts, feelings, or behaviors.

Life transitions

Difficulty adjusting to major life changes such as divorce, job loss, grief, or relocation.

Low self-esteem

Persistent negative self-image, self-criticism, or feelings of worthlessness.

Coping skill deficits

Relying on unhealthy coping strategies such as avoidance, substance use, or self-harm.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Cognitive Behavioral Therapy (CBT) for depression, anxiety, and trauma

Dialectical Behavior Therapy (DBT) for emotional dysregulation

Acceptance and Commitment Therapy (ACT)

Psychodynamic therapy for insight and pattern recognition

Motivational Interviewing (MI)

Group therapy for social anxiety, grief, and skill-building

When to Seek Help

Counseling is beneficial for anyone experiencing emotional distress, life challenges, or mental health symptoms — you do not need to be in crisis to benefit from therapy. Starting therapy early prevents problems from escalating.

Related conditions we treat

Anxiety Disorders Depression PTSD & Trauma Mood Disorders

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

DSM-5 · E66

Weight Management

Psychiatric support for weight management addresses the emotional, behavioral, and neurobiological factors that drive eating and activity patterns.

DSM-5 Clinical Definition

"Behavioral and psychological factors affecting medical conditions, including obesity, involve complex interactions between mental health, behavior, and physical health."

Weight management from a psychiatric perspective addresses the psychological and behavioral factors that contribute to weight gain and difficulty losing weight. These include emotional eating, binge eating disorder, depression, anxiety, medication side effects, and sleep disorders. A psychiatric approach to weight management focuses on sustainable behavioral change, addressing underlying mental health conditions, and — when appropriate — medication-assisted weight loss.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Emotional eating

Using food to cope with stress, boredom, sadness, or anxiety rather than physical hunger.

Binge eating episodes

Consuming large amounts of food rapidly with a sense of loss of control, often in secret.

Medication-related weight gain

Weight gain as a side effect of psychiatric medications (antidepressants, mood stabilizers, antipsychotics).

Depression and inactivity

Low mood and fatigue reducing motivation for physical activity and healthy food choices.

Sleep disruption

Poor sleep increasing hunger hormones (ghrelin) and reducing satiety signals (leptin).

Negative body image

Shame, self-criticism, or avoidance of physical activity due to negative feelings about one's body.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Treatment of underlying psychiatric conditions (depression, anxiety, binge eating)

Medication review and optimization to minimize weight-related side effects

Behavioral activation and structured activity planning

Cognitive Behavioral Therapy (CBT) for emotional eating

Sleep optimization to regulate hunger hormones

Coordination with primary care for comprehensive weight management

When to Seek Help

Seek psychiatric support for weight management when emotional factors, mental health conditions, or psychiatric medications are contributing to weight challenges. A psychiatric approach addresses root causes rather than just symptoms.

Related conditions we treat

Anxiety Disorders Depression Sleep Disorders Eating Disorders

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

Person on video call for telehealth psychiatric appointment

DSM-5 · Z76.89

Telehealth Psychiatry

Telehealth psychiatry delivers the same evidence-based care as in-person visits — from the comfort and privacy of your home.

DSM-5 Clinical Definition

"Telehealth services provide equivalent clinical outcomes to in-person care for the majority of psychiatric conditions, with the added benefit of increased access and reduced barriers."

Telehealth psychiatry uses secure video technology to deliver psychiatric evaluation, diagnosis, medication management, and therapy to patients across North Carolina. Research consistently shows that telehealth psychiatric care produces outcomes equivalent to in-person care for most conditions. Telehealth removes barriers including transportation, geographic distance, childcare, work schedules, and stigma — making mental health care accessible to more people.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Geographic barriers

Living in a rural area or far from psychiatric providers, making in-person care difficult or impossible.

Transportation challenges

Lack of reliable transportation, disability, or inability to drive limiting access to in-person care.

Schedule constraints

Work, childcare, or school schedules making it difficult to attend in-person appointments during office hours.

Stigma concerns

Preference for privacy and discretion in seeking mental health care, avoiding being seen at a clinic.

Mobility limitations

Physical health conditions, chronic pain, or disability making travel to appointments difficult.

Continuity of care

Need to maintain established psychiatric care when relocating or traveling within North Carolina.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Psychiatric evaluation and diagnosis via secure HIPAA-compliant video

Medication management and prescription services

Individual therapy and counseling via telehealth

Follow-up appointments and medication adjustments

Crisis support and safety planning

Available statewide across all 100 North Carolina counties

When to Seek Help

Telehealth psychiatry is appropriate for most mental health conditions that do not require in-person physical examination or emergency intervention. If you are in North Carolina and need psychiatric care, telehealth makes it possible regardless of where you live.

Related conditions we treat

ADHD Anxiety Disorders Depression Medication Management

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

DSM-5 · Z71.89

Mental Health Coaching

Mental health coaching bridges the gap between therapy and everyday life — building skills, resilience, and goal achievement.

DSM-5 Clinical Definition

"Coaching focuses on building strengths, developing coping strategies, and achieving personal goals in collaboration with a trained mental health professional."

Mental health coaching is a collaborative, goal-oriented process that helps individuals develop skills, build resilience, and achieve personal and professional goals. Unlike therapy, coaching focuses on the present and future rather than processing past trauma. It is particularly effective for individuals managing chronic mental health conditions who want support in applying coping skills to daily life, or for those seeking personal growth without a diagnosable condition.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Feeling stuck

Difficulty making progress toward personal or professional goals despite motivation and effort.

Stress management challenges

Difficulty managing daily stressors, leading to burnout, overwhelm, or chronic tension.

Work-life balance issues

Struggling to maintain boundaries between work and personal life, leading to exhaustion.

Low confidence

Self-doubt, imposter syndrome, or difficulty asserting needs and boundaries in relationships.

Life transition challenges

Navigating major changes — career shifts, relationship changes, parenthood, retirement — without clear direction.

Skill application gaps

Having learned coping skills in therapy but struggling to apply them consistently in daily life.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Goal-setting and action planning with accountability

Strengths-based assessment and development

Stress management and resilience-building techniques

Mindfulness and self-compassion practices

Communication and boundary-setting skills

Integration of psychiatric treatment with daily life goals

When to Seek Help

Mental health coaching is appropriate when you want support in achieving goals, building skills, or navigating life transitions — even without a diagnosable mental health condition. It complements psychiatric treatment and therapy.

Related conditions we treat

Anxiety Disorders Depression Mood Disorders Individual & Group Counseling

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

DSM-5 · F32–F53

Women's Mental Health

Women experience unique mental health challenges across the lifespan — from hormonal fluctuations to reproductive transitions and trauma.

DSM-5 Clinical Definition

"Women are disproportionately affected by depression, anxiety, PTSD, and perinatal mood disorders, often influenced by hormonal, social, and biological factors unique to female physiology."

Women's mental health encompasses the unique psychiatric needs of women across the lifespan, including premenstrual dysphoric disorder (PMDD), perinatal mood and anxiety disorders (postpartum depression, postpartum anxiety, postpartum psychosis), perimenopause-related mood changes, and the higher rates of depression, anxiety, PTSD, and eating disorders seen in women. Hormonal fluctuations, reproductive transitions, and gender-specific social stressors all contribute to women's distinct mental health profile.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Premenstrual dysphoric disorder (PMDD)

Severe mood symptoms in the luteal phase of the menstrual cycle: depression, irritability, anxiety, and physical symptoms.

Postpartum depression

Persistent sadness, anxiety, exhaustion, and difficulty bonding with baby following childbirth.

Perinatal anxiety

Excessive worry, panic attacks, or intrusive thoughts during pregnancy or the postpartum period.

Perimenopause mood changes

Depression, anxiety, irritability, and cognitive changes associated with hormonal fluctuations during perimenopause.

Trauma and PTSD

Women are twice as likely as men to develop PTSD following trauma, including sexual assault, domestic violence, and childhood abuse.

Eating disorders

Women account for approximately 85% of eating disorder diagnoses, often beginning in adolescence or young adulthood.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

SSRIs/SNRIs for PMDD, postpartum depression, and anxiety

Brexanolone (Zulresso) for severe postpartum depression

Hormone-informed psychiatric evaluation and treatment

Trauma-focused therapy (EMDR, CPT, TF-CBT)

Cognitive Behavioral Therapy (CBT) for perinatal mood disorders

Coordination with OB/GYN for integrated reproductive mental health care

When to Seek Help

Seek evaluation for any mood or anxiety symptoms that appear to be linked to hormonal changes, the menstrual cycle, pregnancy, or the postpartum period. Perinatal mood disorders are common and highly treatable — early intervention protects both mother and baby.

Related conditions we treat

Anxiety Disorders Depression PTSD & Trauma Eating Disorders

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.

DSM-5 · Z79

Medication Management

Expert psychiatric medication management ensures you receive the right medication, at the right dose, with ongoing monitoring and adjustment.

DSM-5 Clinical Definition

"Pharmacotherapy is a cornerstone of evidence-based psychiatric treatment, requiring ongoing evaluation, dose optimization, and monitoring for efficacy and tolerability."

Psychiatric medication management involves the ongoing evaluation, prescribing, monitoring, and adjustment of psychiatric medications by a qualified prescriber. As a board-certified Psychiatric Mental Health Nurse Practitioner (PMHNP-BC), Zoe Karpee provides comprehensive medication management for a full range of psychiatric conditions including depression, anxiety, ADHD, bipolar disorder, PTSD, OCD, and psychotic disorders. Medication management includes initial evaluation, medication selection, dose titration, side effect monitoring, and coordination with other providers.

Ready to get help?

Board-certified PMHNP-BC Zoe Karpee provides evidence-based psychiatric care in East Flat Rock, NC and statewide via telehealth.

Book an Appointment (828) 316-5548

New patients welcome · Telehealth statewide

Signs & Symptoms

Symptoms vary by individual. A clinical evaluation is required for diagnosis.

Inadequate symptom control

Current medications not providing sufficient relief from psychiatric symptoms.

Medication side effects

Experiencing troublesome side effects from current psychiatric medications requiring adjustment.

New psychiatric diagnosis

Recently diagnosed with a psychiatric condition and needing initial medication evaluation.

Polypharmacy concerns

Taking multiple psychiatric medications and needing expert review for interactions and optimization.

Treatment resistance

Not responding to standard first-line medications and needing augmentation or alternative strategies.

Medication transitions

Needing to safely switch from one psychiatric medication to another.

Evidence-Based Treatment

At Wellness Behavioral Health and Healing PLLC, treatment plans are individualized and grounded in the latest psychiatric evidence. Options may include:

Comprehensive psychiatric evaluation to guide medication selection

Evidence-based prescribing aligned with current clinical guidelines

Careful dose titration and tolerability monitoring

Pharmacogenomic testing when appropriate

Coordination with primary care and specialists

Patient education about medications, expected timeline, and side effects

When to Seek Help

Seek medication management if your current psychiatric symptoms are not adequately controlled, if you are experiencing medication side effects, or if you have never been evaluated for psychiatric medication and are struggling with a mental health condition.

Related conditions we treat

ADHD Anxiety Disorders Depression Bipolar Disorder

You don't have to navigate this alone.

Zoe Karpee, PMHNP-BC, offers compassionate, evidence-based psychiatric care in East Flat Rock, NC and across North Carolina via telehealth. New patients welcome.

Book an Appointment (828) 316-5548

Telehealth available statewide in North Carolina · In-person in East Flat Rock (Henderson County)

Medical Disclaimer: This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for diagnosis and treatment of any mental health condition.