It is estimated that anxiety disorders affect more than 17 million Americans. These conditions, which are considered to be serious medical illnesses, require specialized treatment services. Extensive research in the past several years confirms that there are effective treatments that help decrease and even eliminate anxiety that previously may have been disabling.
Anxiety is the result of fear. When we are afraid, our body responds by producing physiological symptoms such as heart palpitations, sweating, trembling or shaking, shortness of breath, dizziness, and chest pain or discomfort. These symptoms tend to produce a “fight or flight response” which causes us to take action so that we can be “safe.” Typically ones instinct is to go into a “flight” response, rather than stay and “fight” what is scaring us. Hence, we often times see individuals whose lives have become significantly limited due to avoidance of the situations that are producing the anxiety.
According to the Diagnostic Statistical Manual of Mental Disorders (DSM IV), there are 11 forms of Anxiety Disorders. While these disorders may vary in terms of etiology, they share several similar characteristics. For instance, these disorders can cause both physiological and psychological distress. Without treatment often times symptoms will become worse, impairing one’s social, occupational, vocational, and other key areas in one’s life.
Obsessive Compulsive Disorder (OCD) is diagnosed when an individual has intrusive thoughts, images, or impulses (obsessions) that they find distressing, uncomfortable, and often times, intolerable. In an attempt to neutralize, or make these obsessions go away, behaviors are created (compulsions). Unfortunately, the compulsions, while providing temporary relief, do nothing to make the obsession, which is typically based in fear, go away. The compulsion actually acts to reinforce the condition of OCD, and what begins to emerge is patterned behaviors that can eventually run, even devastate, one’s life. As such, a formal diagnosis is made only when the symptoms are interfering or impacting one’s daily activities, social or interpersonal relationships, and/or educational/vocational endeavors. This is an important note, as many people can have symptoms of OCD, yet not have a diagnosis of OCD.
OCD can take on a variety of forms, including those most frequently spotlighted in the mainstream media: checking and washing. We, however, feel it’s important to stress that there is no typical way in which OCD manifests itself. It has many faces and disguises and can surface in ways that many would not believe. For instance, imagine waking up in the middle of the night and suddenly having the fear that you might stab your spouse. Most can expect that thought would be terrifying. Let’s think about the person that’s afraid that if he doesn’t “confess” every sin to God, or his “higher power,” that he will be damned to eternal hell. How about the person that fears if she doesn’t walk through the same door she entered that someone she loves will die? These are just some of the examples of what OCD can look like.
Below is a list of other common obsessions and examples of what some related compulsions might look like. Please keep in mind this is not an exhaustive list.
|Common Obsessions||Possible Compulsions|
|Fear of becoming a child molester.||Avoidance of looking at children or being around children; avoidance of certain movies.|
|Fear of throwing up/getting sick/having a medical illness.||Avoidance of certain foods; repeated visits to the doctor for reassurance; reassurance seeking on the internet; avoidance of people who are (or appear) ill; taking temperature repeatedly.|
|Fear of going crazy (often times stems from fear of not sleeping).||Asking for reassurance from others that there is nothing wrong with them; researching the internet.|
|Fear of homosexuality/being gay.||Avoidance of looking at the same sex, including pictures; looking at opposite sex for reassurance of attraction;|
|Fear of not doing a particular act and something “bad” happening.||Retracing steps; mentally reviewing; tapping certain number of times; counting.|
|Fear of acting out in a sexually inappropriate manner.||Avoidance of walking to close to people; reassurance questions that they did not do anything inappropriate; mentally reviewing the days events/actions.|
|Fear of being drugged.||Avoidance of restaurants; eating only from sealed packages; eating only from personally prepared food.|
|Fear of pregnancy.||Avoidance of sitting on chairs where males have sat; avoidance of touching places that men have touched; avoidance of towels men have used.|
|Fear of urine/feces.||Avoidance of public restrooms; avoidance of doorknobs; excessive hand washing/showering/cleaning.|
|Fear of not doing things perfectly.||Rearranging; re-reading; re-writing; putting things in a certain place or order.|
|Fear of committing blasphemy/sin.||Praying; researching; confessing; reassurance questions directed toward religious figures.|
|Fear of AIDS/HIV/Herpes/blood/germs.||Excessive hand washing; showering; cleaning; researching on the internet; avoidance of touching objects feared to be “contaminated.”|
|Fear that something bad will happen to a loved one.||Staying close to loved one; reassurance questions about where the loved one will be.|
What’s important to remember–and this is key–most people have intrusive thoughts that bother them. In fact, it is considered to be quite rare, if not highly improbable, for people not to experience some form of intrusive thoughts in their lives. In this context, the thought is in one’s awareness, but it tends to disappear just as quickly as it entered. There is no feeling attached to the thought. It is, in essence, harmless. What makes OCD sufferers different is that they question their thoughts, and begin to “doubt” whether what they fear might actually come true. Consequently the fear, which is now in experienced as being in the realm of possibility, needs to be extinguished, which in OCD, is channeled through compulsions. Unfortunately, because the feared consequences are irrational, illogical, and improbable, the compulsions do nothing to reduce the fear. So, because OCD is rooted in a physiologically-based chemical imbalance, the fear remains, and the more compulsions one does, the more those compulsions actually feed the condition. Hence, the world of the OCD sufferer becomes increasingly limited, and ultimately controlled by compulsions.
We would like to note some important points.
- There is no case history of anyone with a diagnosis of OCD who has actually acted on a feared thought or impulse.
- OCD is only diagnosed when one recognizes his/her obsessions as being irrational and illogical. If one believes in the feared thoughts, then other diagnoses should be considered.
- Very rarely does a person have “Pure O,” meaning obsessions without compulsions. When one is obsessing, one is actually mentally compulsing.
- OCD is treatable.