Anxiety Disorders and OCD

Anxiety disorders

Further reading - NIMH

Anxiety is your brain's threat detection system: it's how you identify and prepare for trouble, and it's a normal, healthy emotion. It becomes a problem when it's disproportionate to the actual danger, and when it starts causing real distress and impairment.

It takes a lot of forms: chronic worry, fear of embarrassment or rejection, panic attacks that stop you in your tracks, phobias about specific places or things. Whatever the source, it's exhausting. Worse, it shrinks your life down to a small bubble of what feels "safe" - so you hold back from things you actually want, relationships included. A lot of people with anxiety just white-knuckle their way through it in silence.

Common forms

• Agoraphobia. Fear of situations where escape feels hard, or help might not be available. Common triggers: transportation (planes, buses, cars), open spaces (parking lots, bridges), enclosed spaces (a packed shop, a movie theater, being stuck in traffic), crowds or lines, or being outside the home alone.
• Generalized Anxiety Disorder (GAD). Chronic worry and stress that spreads across a lot of subjects, not just one. People with GAD often call themselves "worry warts": they have a hard time unwinding, feel tense or irritable, and end up exhausted from the stress of it. Falling asleep can be its own fight when your mind won't stop worrying.
• Panic attacks. A sudden, intense surge of fear or physical discomfort, usually lasting 5 to 15 minutes. Common symptoms: a racing heart, chest tightness, shortness of breath, sweating, chills or heat flashes, nausea, shaking, dizziness, numbness or tingling, even a dreamlike sense of unreality. It feels like something is seriously wrong, but a panic attack itself isn't medically dangerous.
• Panic Disorder. Some people who have recurrent panic attacks develop an overwhelming fear of having another one. That fear turns into constantly scanning your body for warning signs, becoming hyper-aware of normal physical sensations, and avoiding places that feel risky.
• Specific phobias. An intense fear of one particular object or situation - heights, spiders, even clowns. People go out of their way to avoid the trigger entirely, or white-knuckle through overwhelming anxiety if they can't.
• Social Anxiety Disorder. Sometimes called social phobia, this comes from a powerful fear of embarrassment, rejection, or humiliation around other people. It shows up as intense anxiety, shyness, or the urge to avoid social situations altogether.
• Performance anxiety. A subtype of social anxiety tied specifically to performing in front of others. You might feel fine in most social situations but fall apart at public speaking, playing music for an audience, or competing in a sport with people watching.

Here's the good news: anxiety responds to treatment, and a lot of people make real progress with Cognitive Behavioral Therapy, the gold-standard approach for anxiety. I combine CBT with mindfulness and Acceptance and Commitment Therapy, so you can get back to what's important to you instead of managing around the anxiety.

Obsessive-Compulsive Disorder

Further reading - NIMH

OCD is misunderstood constantly, and many cases go unrecognized and untreated because of this fact. Popular culture has a very narrow, limited idea of what OCD is: people picture germaphobes who like things tidy, but that's only a small slice of what OCD actually looks like. At its core, OCD is built from two parts:

• Obsessions. Unwanted, intrusive thoughts, urges, or images that cause real distress. They're uncomfortable enough that you actively try to ignore, avoid, or eliminate them.
• Compulsions. Repetitive behaviors (hand washing, ordering, checking) or mental rituals (praying, counting, repeating a phrase) done to neutralize the anxiety an obsession causes, or to satisfy a strict internal rule. They're meant to bring relief, but they're irrational or way out of proportion to the actual situation.

OCD is driven by thoughts that are "sticky" and hard to ignore - which is exactly why intrusive thoughts tend to latch onto whatever you find most uncomfortable, scary, or disturbing. Another common thread is a deep difficulty with uncertainty ("did I really turn the stove off?"), which is where the nickname "the doubting disease" comes from: OCD can make you question your own memory or your own senses. Compulsions offer some relief, but it works like scratching a poison ivy rash - the itch just keeps coming back stronger.

Common themes

• Contamination. Fear of becoming contaminated by germs, dirt, or anything that feels "unclean."
• Symmetry. Needing things ordered, repeated, or counted a certain way.
• Checking. Checking and re-checking that something is safe - stoves, locks, and lights are common targets.
• Harm. Intrusive thoughts of accidentally hurting someone (while driving, say) or losing control and hurting someone on purpose.
• Sexual orientation or gender identity. Obsessive doubt about whether you're actually a different sexual orientation or gender identity than you believe yourself to be.
• Scrupulosity. Constant worry that you've done something immoral or sinful.
• Health. Excessive fear that something is medically wrong with you.
• Relationship. Constant rumination, checking, and reassurance-seeking to settle doubts about a relationship.
• Hoarding. Difficulty getting rid of possessions, regardless of their actual value, because it feels necessary to keep them - which ends up creating serious clutter.

You don't have to fight this alone. Decades of research back Exposure and Response Prevention as the most effective treatment we have for OCD, and it's the core of how I treat it.

I also use Inference-Based Cognitive Behavioral Therapy (ICBT), a newer approach that targets the reasoning behind the doubt instead of the anxiety it produces. ERP asks you to approach the fear without doing the compulsion. ICBT instead traces how you talked yourself out of trusting your own senses in the first place. For some people it's the better fit, and it's a good option if you've tried ERP and it was intolerable or if you only made limited progress.