Clinical Services / Educational Services / Organizations / E-Mail  

Atlanta Medical Psychology
The clinical practice of Dr. David B. Adams is located in The Medical Quarters in the northside of Atlanta at the junction of Scottish Rite, Northside and Saint Joseph's Hospitals. Dr. Adams consults to occupational medicine, surgeons, nurse case managers, insurers and employers regarding the psychological impact of work-related injury and the role of psychological factors in short- and long-term disability. 

January 3, 2000

Q "My daughter will repeat, almost silently, to herself questions that she asks. That is, she will ask a question and then re-state it in a barely audible whisper. I have heard of echolalia in schizophrenic children, but she seems very normal. It is frightening to think of this as being the beginning of schizophrenia."

A You have no information that would suggest that this is related to schizophrenia. If you are concerned, or if there are other symptoms, you may wish to seek a psychological consultation. However, Transient Tic Disorder may occur many times per day, nearly every day for at least four weeks but no longer than 12 consecutive months (at which time they would be considered "chronic." A transient tic disorder obviously may cause impairment in social and/or occupational functioning and is not substance induced or the result of some disease process (for example, Huntington's Disease). The onset, as with chronic motor or vocal tic disorder, is before the age of eighteen, and can involve single or multiple motor and/or vocal tics. These may be rapid, recurrent, nonrhythmic movements or vocalizations. 

January 10, 2000

Q "I would imagine that you have been asked this a great deal recently, but if a public figure says something that others consider inappropriate, is this reason for a psychological examination?"

A You are correct; this is a very popular question at present. Let me counter your question with a broader question: 

`Is it possible for someone to express their opinion, for that opinion to be unpopular or even to some, inappropriate, but for the person to be psychologically normal'?

The true purpose of a psychological examination is to determine:
a. if there is care that an individual needs,
b. and/or in forensic (legal) situations to determine whether the individual has voluntary control over reported illegal actions. 

In the former U.S.S.R., such examinations and even "care" was imposed upon political dissidents. In the latter case, such imposed "treatment" was, in fact, punishment.

Ill-timed, unpopular or even blatantly offensive concepts or remarks do not necessarily mean that a disorder is present. And such remarks do not serve as an index of the need for psychological examination and care.

January 17, 2000

Q "My family doctor told me that all behavior is biologically based and that I was wasting both time and money in psychotherapy. I have felt that I have made major changes in my behavior, emotions and thinking as a result of psychotherapy. I do not wish to argue with him, but I do not feel he is correct. Can you tell me your position on this?"

A This has been, for years, referred to as the nature-nurture controversy. Do we learn maladaptively to have the problems we have or are they the result of the way we are biologically constructed. Most reasonable individuals believe that we have biological predispositions to behave in specific ways but that we can, and do, learn to modify those impulses. It is increasingly believed that while there may well be a biological basis for our behaviors, psychotherapy may also be a biological treatment in that there may be significant biological changes in our central nervous systems as a result of psychotherapy.  Thus, he may be correct as to the origin of problems and incorrect as to their solution. Your best evidence should be whether psychotherapy has made a demonstrable impact upon the quality of your life, your relationships and your occupational functioning.

January 24, 2000

Q My internist told me that she felt I was depressed. I told her that I am sick, not depressed and I do not feel sad. I am tired a great deal and have not the interest in things that once interested me...sleep poorly and believe that a lot of this is due to my having gained quite a bit of weight...my problem, I eat a lot of chocolate of late...Do you believe that I could be depressed and not know it?"

A This is a frequent and important question. Clinically depressed individuals may have a range of physical complaints including fatigue and weight change. They often report decrease sexual drive and decreased interest in formerly pleasurable hobbies/activities. They may have difficulty with attention and concentration and be irritable. It is not uncommon to be depressed and not feel "sad." Regardless of what precipitates depression, there are psychotherapeutic and pharmacologic interventions that can be quite effective. Perhaps you should talk more to your internist about her assessment and/or seek psychodiagnostic consultation. You will find more on depression elsewhere on psychological.com.

January 31, 2000

Q "About three years ago I was injured at work. I hurt my lower back. I am only 34 years old, and I feel my life has permanently changed. I have not gone back to work, I have less energy and less patience for my kids, and I am distant from my wife. My wife says that she is prepared for this, that she married me "forever", but I think this is really getting to her. Does she need to see someone to deal with this?" 

A Your situation is not at all unusual. Your limitations have affected not only how you feel physically but how you relate to the family as well as your perceptions of the future. You suggest that you are attempting to deal with this with minimal discussion with your wife and without psychological assistance. This may not be the best way to manage this period of your life.

Your wife may, indeed, need to see a psychologist in order to learn to accept how this has impacted you, her and the children. You may also want to consider being seen conjointly by a psychologist or as a family since it appears that several areas of life are being impacted.

February 7, 2000

Q "My sister has placed herself in a very bizarre situation. She creates "relationships" in which she is mistreated and humiliated. These all have a strong sexual aspect, and it is all rather embarrassing. I think she has more than one problem. This is not my field, but I believe she is dependent and frustrated, but the outward behavior seems to run very close to risk to personal safety. What would be at least one of the major concerns?"

A Sexual Masochism involves the very real act of being humiliated, bound, beaten and otherwise made to physically suffer for purposes of sexual stimulation. While the fantasy of such things is not unusual, it is the acting upon these fantasies that can run the risk of true peril.

These patterns of behavior are not only disruptive to social and occupational functioning, but they run the risk of threat to physical safety. Hypoxyphilia for example, involves the cutting off of oxygen supply for purposes of sexual stimulation. One to two deaths per million may be attributable to this practice. While some may engage in minor sexual masochism, there are those who increase the risk to safety over the years, often thereby insuring that the risk of serious injury occurs.

February 14, 1999

Q "This may seem like a naive question, but what is cross dressing. Are these guys or girls who want to be the opposite of what they are?"

A Transvestic Fetishism involves a male who  maintains a collection of female clothing that he intermittently utilizes for cross-dressing. This occurs in heterosexual males and is not part of Gender Identity Disorder. Some will wear a single item of apparel under masculine clothing. These heterosexual males may have very few sexual partners and have occasional homosexual relationships. When not cross-dressing, they may behave in stereotypic male fashion but this behavior may be quite feminine when wearing women's clothing. It may be a means of reducing anxiety or depression, but in some cases, it can give rise to gender dysphoria (discontent with one's own gender). Thus, the motivation for cross dressing may change over time. Clinically significant problems in social and occupational roles are most often the result.

February 21, 2000

Q "Many of my patients are divorced and many have, or have had, sexual problems or conflicts. Do you have any statistics of American marriages, sexual preference and other demographics of the American family?"

A In 1997, there were 2.3 million marriages. Sixty percent of Americans were married at that time, 23% had never married, 9% were divorced, and 7% were widowed.

Fifteen percent of Americans are single parents, 45% rely upon dual income and only 20% maintain the traditional breadwinner/homemaker roles.

Fifty-three percent of couples have no children. The average is 1.84 children per family. Sixty-eight percent live with mom and dad; twenty-four percent live with their mother; 4% live with their father.

Six percent of families have incomes above $100k and sixteen percent have incomes below $10k.

Eleven percent of males had been sterilized as compared to 28% of females. Seven percent of women are homosexual, and thirteen percent of males.

Of the 1.3 million prostitutes in the U.S., 500 thousand were under the age of 18, and 100 thousand of all prostitutes had been arrested.

Thirty-eight percent of girls under sixteen years of age were sexually active; 20% become pregnant.

February 28, 2000

Q "A young man in our community was arrested for being a "peeping Tom." In the newspaper, his defense was that this was a serious psychological problem that needed treatment and not something over which he had control. Is this a lame attempt at defense for what he simply wants to do?"

A Voyeurism - the paraphilliac focus of the voyeur is to observe unsuspecting individuals who are naked, in the process of disrobing, or engaging in sexual activity. The goal of the observing is to elicit sexual excitation in the observer, not to seek sexual contact with those being observed. The memories or the activity itself can be used by the voyeur to produce sexual gratification. Onset is typically before the age of fifteen, and the individual may become so invested in the voyeuristic activity as to have this as the sole sexual behavior. This often is a chronic condition.

March 5, 2000

Q I recently read about a boy that due to a surgical error they tried to raise as a girl but he refused. Even though he had no knowledge that he had been born a boy, and even though being raised as a girl, he still felt he was a boy. He said he was miserable as a girl. Does this have to do with sexual identity?"

A Gender Identity Disorder consists of a strong identification with the opposite gender. The individual may insist that he/she is the other sex, cross-dressing and/or stereotypic attire, preference for cross-sex roles, cross-sex games and pastimes, and preference for playmates of the opposite sex. There is a pervasive feeling that one's own sexual identity is inappropriate and include disgust with one's genitals and/or rejection of sexual roles. In adults it may include request for surgery, hormonal treatment and other attempts at physical alteration.

March 12, 2000

Q "One of my coworkers has been arrested and accused of raping a woman at work. I feel that this could have been prevented because he was very aggressive on dates, has been arrested before for harming his sexual partners, and talked to males at work about punishing or humiliating women. What is wrong with him?"

A Sexual Sadism is diagnosed when over a period of at least six months, the individual has intense and recurrent, sexually arousing fantasies, urges and actions (not simulated) in which psychological or physical suffering (including humiliation) is suffered by another and is sexually exciting to the perpetrator. Age of onset is commonly by early adulthood. The sadism may take the form of restraining, beating, torturing, mutilating or even killing another (especially when associated with anti-social personality disorder). If committed with a non-consenting cohort, the behavior may continue until the individual perpetrating the acts is apprehended.

March 19, 2000

Q "Is there a disorder that describes these people on subways who deliberately bump or rub up against you? Surely, there is something wrong with these people."

A Frotteurism is the term used to describe a sexual disorder in which individuals have recurrent intense sexually arousing fantasies and urges involving the need and action of touching or rubbing against nonconsenting persons. Most of these individuals are males in their mid-to-late teens and twenties. They chose public situations in which they can often then escape without prosecution and/or even avoid detection by the victim. During the action, they often fantasize of a relationship with the individual whom they are touching.

March 26, 2000

Q "I read recently that some of the men and women who work as "dancers" in adult clubs may suffer from a sexual disorder, but the article was vague. I think they may have been referring to the individual's need to be watched or looked at...can you explain this?."

A Exhibitionism involves intense, recurrent and sexually arousing fantasies involving the exposure of the individual's genitals. This may, in turn, translate into putting this fantasy into action and engaging in these behaviors. However, a key feature of this need is that the individual be a stranger or unsuspecting. It may not widely apply to individuals who expose themselves for salary/tips and for whom their audience is anticipating the behaviors.