Anxiety Disorders

Obsessive Compulsive Disorder (OCD)

Anxiety and OCD

OCD is an anxiety disorder where people get stuck in obsessions and develop compulsions as a way of coping. Compulsions only worsen the anxiety in the long term. Treatment can be very effective.

Obsessions:  unwanted thoughts, images, or urges.  Obsessions cause significant distress and have consequences that the person fears (Ex:  an obsessing over an illness and the fear is dying).

What are common obsessions:  contamination, harm to self/others, rethinking the meaning of a thought or behavior, worry about forgetting, loss of a person or possession, misunderstanding or being misunderstood, experiencing anxiety, imperfection, attention to thoughts or body.

Compulsions: behaviors that are developed to decrease or neutralize the anxiety caused by obsessions.  They may or may not be directly related to the obsession. Compulsions maintain the anxiety by creating short-term relief but the anxiety gets stronger in the long-term as the compulsions and avoidance continue. (Ex:  a compulsion of hand washing to reduce both the obsession of an illness and the overall fear of dying).  Compulsions take up a great deal of time and interfere in other activities and ways of functioning. 

What are common compulsions:  decontamination (hand washing, disinfecting), checking (doors, stove), perfectionistic (having symmetry, order), counting, touching, mental (rethinking, memorizing, repeating), body focused checking or grooming, hoarding.

Treatments OCD:  The treatment that works for OCD is a type of Cognitive Behavior Therapy (CBT) called Exposure and Relapse Prevention (ERP). 

How does Exposure and Response Prevention work:  The exposure part of ERP involves gradually approaching specific thoughts, images, situations, and objects that are linked to obsessions (i.e., sitting with dirty hands when the obsessive thought is related to contamination). 

The response prevention part of ERP is learning to avoid the compulsion that generally relieves the anxiety or discomfort (i.e., do not wash dirty hands in response to the contamination worry and instead tolerate the emotions while having dirty hands). 

Effective OCD treatment uses both exposure and response prevention. The goal of exposure therapy in OCD is to disconfirm previous fears, create new learning that the feared situation is relatively safe, and anxiety is tolerable.  

How to treat severe OCD?:  The treatment approach is the same for severity of symptoms, as well as the type of OCD.  A combination of medications and treatment can be more effective for more severe cases.  

Body Dysmorphic Disorder (BDD)

Anxiety and BDD

BDD is considered an Obsessive Compulsive spectrum disorder, as there are both obsessions and compulsions present.  The obsessions are unwanted, and persistent and the compulsions reduce the anxiety from obsessions -just the same as in OCD. 

Obsessions in BDD: The obsessions in BDD are more specifically related to the body (often obsessed about one’s perceived or actual flaws).  People with BDD have been found to have more attention to detail and overly focus on details of the body, especially facial features.

Compulsions in BDD: The compulsions in BDD are frequently related to mirrors (avoiding mirrors and/or repeatedly checking mirrors, binocular like focus at an identified flaw when looking in the mirror).  Other compulsions in BDD can include covering up the flaws or one’s body in general, attempting to appear more muscular, rituals with clothing (avoiding, frequently changing) and assurance seeking related to appearance.  Panic attacks related to the body can also occur, and common times are during showers or in front of mirrors.  Symptoms interfere in social and emotional functioning – often in the form of avoiding or withdrawing. 

What is the difference between OCD and BDD: Though the disorders and the treatments are very similar, there are also differences. People with BDD can experience increased concerns in the following areas: self-esteem, depression, and suicidality.

Treatment for BDD:  Cognitive Behavior Therapy (CBT) is the main treatment for BDD.  Mindfulness, self-compassion, and Behavior Activation strategies are helpful along side CBT to reduce overall depression, anxiety, and low self-esteem that is often co-occurring with BPD.

CBT for BDD includes: 

  1. ERP (facing fears while at the same time refraining from rituals – i.e., going to a social gathering and avoiding repeated mirror checking, going into a store without disguising a part of the body that brings distress, over time developing an average relationship with mirrors).
  2. Increase effective thinking (challenge distorted thoughts, increase mindfulness to thoughts, and participate in behavior experiments to confirm or disconfirm body image beliefs).
  3. Increase attentional control (learn non-judgmental and more holistic attention to oneself instead of narrow attention only on the flaw).  

Panic Disorder

Anxiety and Panic

A panic attack is an experience of intense fear and abrupt, short lasting changes in body symptoms.

Panic attack physical symptoms:  can include feeling short of breath, increased heart rate, sweating, and an urge to flee the situation you are in.  Many can end up in the hospital believing they have a medical condition (such as a heart attack) but are actually experiencing panic. 

Recurrent panic attacks can become panic disorder.  And panic disorder can lead to Agoraphobia, which includes either avoidance or extreme dread of situations that an escape is either difficult or unavailable (going in public, stores, crowds, using public transportation).

How to treat Panic Disorder: Exposure therapy is the most evidence-based therapy for panic.  This includes facing situations that cause anxiety and panic as a way to regulate the anxiety.  Breathing and thinking skills are taught to use during and after exposure situations.  


Anxiety and Perfectionism

Having high standards can be very healthy.  It is important to distinguish between effective goal setting with high standards and perfectionism. 

What does it mean to be perfectionistic: A perfectionist can set unrealistic goals across areas of their life and have extreme reactions to their perceived or actual failures (low sense of worth, judgments, avoiding or relentlessly persisting behaviors).  Sense of self-worth is often measured by achievements (perceiving self as a failure or actually not achieving = low worth).  Perfectionistic standards can interfere in many areas of life.

Treatment for Perfectionism:  There can be a variety of approaches to reduce perfectionism.  Cognitive Behavior Therapy teaches people to do behavior experiments and increase tolerance to not being perfect, as well as change unhelpful thinking.  Self-compassion therapy teaches people to mindfully reduce critical thinking and to instead learn how to offer oneself curiously kind, gentle, accepting support. Reducing perfectionism does not mean eliminating goals or standards. It is learning to find the middle ground of maintaining high achieving behavior in some (possibly not all) contexts.  

More Anxiety Disorders

General Anxiety Disorder (GAD) includes persistent and unrealistic worry about the unknown (future, school, work, money, and others).  The worry can interfere in sleep, concentration, relationships, and life.  Anxiety effects people physically with body tension and behaviorally with either avoiding situations or extra cautious behaviors when in situations. 

Social Anxiety Disorder (SAD) includes worry specifically related to being around others. There may be extreme fears of embarrassment or humiliation around others and often avoidant behavior in social situations (avoiding eye contact, hanging back, worrying about perceptions of others).

Specific Phobias are fears that are persistent and/or the fear disrupts the person’s life.  Common types of phobias can be dogs, spiders, blood, heights, small rooms or spaces.

Treatments for GAD, SAD, and Phobias include Cognitive Behavior Therapy (CBT) to challenge anxious thoughts and approach anxious situations – including Behavior Activation Therapy and Exposure Therapy to face the fears.