Anxiety & Obsessive Compulsive Spectrum Disorders

Generalized Anxiety Disorder (GAD) is often experienced as persistent and excessive worry that feels out of control. The worry can be about any number of things and when one cause of worry is resolved, the anxiety seems to shift to another cause. Topics of worry can include health, finances, relationships, work, and other issues. At times it may feel like a cloud of anxiety rolls through which leads to mental scanning trying to find the “cause” of the feeling. Other symptoms that go with this pervasive worry can be sleeping problems, muscle tension, irritability, trouble concentrating, fatigue, and feeling restless or on edge.

Obsessive Compulsive Disorder (OCD) can appear in many different forms, and one sufferer’s symptoms might be quite different from another’s symptoms. What is in common between all types of OCD are the presence of unwanted, intrusive thoughts, images, or impulses that cause distress (obsessions) and rituals, routines, thoughts, or other behaviors (compulsions) that are intended to reduce the anxiety from the thought and the possibility of the unwanted occurrence happening. For people who have OCD, these obsessions and compulsions are time consuming and get in the way of doing important and valued activities. Many people with OCD know the thoughts are irrational but they feel powerless to stop doing the compulsions.

Some common types of obsessions are:

• Contamination: fears of dirt, germs, chemicals, or bodily fluids
• Perfectionism: preoccupation with symmetry, order, or not forgetting or losing things
• Losing Control: fearing acting on an impulse to hurt oneself or others, violent images, saying inappropriate things, or stealing things
• Harm: fearing accidentally or purposefully harming oneself or others, feeling overly responsible for other’s safety
• Unwanted Sexual Thoughts: Taboo, perverse, or aggressive sexual thoughts or excessive worry about sexual or gender orientation,
• Religious Obsessions (Scrupulosity): fearing going to hell, offending God, committing a moral offense or preoccupation with knowing if behavior is right or wrong.
• Health: excessive worry about having a particular disease (i.e. cancer)

Common compulsions include

• Cleaning or Washing
• Checking: checking that oneself or others were not harmed or that actions were taken to keep safe
• Repeating: repeating routine activities or movements or rereading/rewriting
• Seeking Reassurance
• Ordering/Arranging Things to ‘Feel Right’
• Mental compulsions: praying to prevent harm, ‘cancelling’ or ‘undoing’ an unwanted thought, reviewing events to prevent harm, or counting to end on ‘good’ or ‘right’ number while doing a task.

Panic Disorder is characterized by having unexpected panic attacks that lead to a preoccupation with fear of future attacks and attempts to prevent them. People with panic attacks often fear that the attack means they are having a heart attack or stroke, will die, will go ‘crazy,’ or lose control. Common symptoms include heart palpitations or pounding, sweating, trouble breathing, chest pain, nausea, gastrointestinal distress, shaking, feeling flushed or clammy, numbness or tingling, and feelings of unreality or feeling detached from oneself.

Sometimes people with Panic Disorder develop Agoraphobia, which is an avoidance of situations or places where the person fears they might have a panic attack again. This can include driving on freeways, being too far away from home, or being in public places and crowds where escape would be difficult if a panic attack happened.

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD) can occur when someone has experienced, witnessed, or faced threat of serious harm to themselves or a loved one. These traumas include natural disasters, terrorist acts, sudden death of a loved one, military combat, serious accidents or injury, and sexual or physical assault as a child or adult.

After the trauma, those who develop PTSD experience four main types of symptoms:

• Reexperiencing: flashbacks, nightmares, intrusive thoughts and images of the event
• Avoidance: emotionally numbing and avoiding people, places, and things that are reminders of the trauma
• Negative changes in thoughts or mood: difficulty remembering parts of the trauma, blaming and having negative beliefs about oneself and others, feeling isolated, and difficulty feeling positive emotions.
• Increased arousal or reactivity: difficulty sleeping, problems concentrating, feeling irritable or on edge, feeling jumpy, and being easily angered.

Posttraumatic Stress Disorder (PTSD) can occur when someone has experienced, witnessed, or faced threat of serious harm to themselves or a loved one. These traumas include natural disasters, terrorist acts, sudden death of a loved one, military combat, serious accidents or injury, and sexual or physical assault as a child or adult.

After the trauma, those who develop PTSD experience four main types of symptoms:

• Reexperiencing: flashbacks, nightmares, intrusive thoughts and images of the event
• Avoidance: emotionally numbing and avoiding people, places, and things that are reminders of the trauma
• Negative changes in thoughts or mood: difficulty remembering parts of the trauma, blaming and having negative beliefs about oneself and others, feeling isolated, and difficulty feeling positive emotions.
• Increased arousal or reactivity: difficulty sleeping, problems concentrating, feeling irritable or on edge, feeling jumpy, and being easily angered.

Social Anxiety Disorder (SAD) is characterized by extreme fear of being scrutinized and judged by others. People with SAD are afraid they will humiliate or embarrass themselves and so avoid being around others, sometimes to the extent that they have few, if any, friends or social or romantic relationships. Others with SAD have symptoms only in certain situations, such as giving a speech or performing, participating in a class, meeting new people, or dating. Physical symptoms of SAD can include increased heartrate or pounding heart, shaking, difficulty speaking freely, blushing, excessive sweating, nausea, and digestive distress.

People with specific phobias have strong, irrational fears to common situations, places, or objects. Phobias commonly occur around animals, insects, driving, flying, public transportation, heights, being in small spaces, and having medical or dental treatment. The intense desire to avoid the phobia can cause problems for people in their work, school, or personal functioning.

Somewhat different, Blood, Injury, Injection (BII) Phobia is a phobia wherein people faint at the experience or prospect of seeing their own or someone else’s blood, an injury, or an injection. This can cause problems as people with BII can avoid important medical or dental care to avoid fainting during the treatment or procedure.

Trichotillomania is a Body Focused Repetitive Behavior (BFRB) characterized by recurrent hair pulling resulting in hair loss that persists even after repeated attempts to stop the behavior. Common areas where people pull hair from are the scalp, eyebrows and eyelashes, though pulling can focus on hair from any part of the body. Emotions occurring before or during hair pulling can include anxiety, frustration, depression, and even boredom. After pulling, many experience shame, embarrassment, or regret. Often the behavior becomes so automatic that the person may not realize they are pulling out hair until after the pull. Trichotillomania can cause tremendous emotional distress, isolation, and difficulties in social, school, and work settings in addition to the risk of physical damage from the repetitive pulling.

Compulsive skin picking is a Body Focused Repetitive Behavior (BFRB) is characterized by rubbing, scratching, picking, and/or digging at one’s skin in attempt to address perceived imperfections. Picking at skin irregularities is something most people do from time to time but in compulsive skin picking, the picking is done to the extent that tissue damage is caused despite repeated attempts to stop. Emotions occurring before or during picking can include anxiety, frustration, depression, and even boredom. After picking, many experience shame, embarrassment, or regret. Picking can cause tremendous emotional distress, isolation, and difficulties in social, school, and work settings in addition to the risk of physical damage from the repetitive picking.

Health Anxiety or Illness Anxiety Disorder (formerly known as Hypochondriasis) is experienced by individuals who become preoccupied with the possibility that they may have a serious medical condition or disease. These fears arise from misinterpreting sensations and symptoms in the body. To relieve the health anxiety, the person may seek reassurance from medical tests, self-monitoring, doctor visits, internet searches, and the reassurances of friends and family. However, the relief gained by these reassurances is brief (if at all) and the anxiety continues. Health anxiety can cause significant obstacles for a person’s ability to function in social, school, and work settings.