Anxiety disorders and related conditions have very specific criteria outlined in The Diagnostic and Statistical Manual of Mental Disorders (DSM V). The most recent edition made several changes and has created new categories to further understand how they are viewed. The following outlines these changes which are all conditions treated at The Anxiety Treatment Center.
Obsessive Compulsive Disorder and Related Conditions:
- Obsessive Compulsive Disorder
- Body Dysmorphic Disorder
- Trichotillomania (Hair Pulling)
- Excoriation Disorder (Skin Picking)
- Hoarding Disorder
- Separation Anxiety Disorder
- Selective Mutism
- Specific Phobia
- Social Anxiety Disorder
- Panic Disorder
- Generalized Anxiety Disorder
Trauma and Stress Related Disorders
- Reactive Attachment Disorder
- Disinhibited Social Engagement Disorder
- Posttraumatic Stress Disorder
- Acute Stress Disorder
- Adjustment Disorders
Below is a description of the anxiety disorders listed above.
Obsessive-Compulsive Disorder (OCD)
OCD occurs when an individual has recurrent and persistent thoughts, images, and/or impulses (Obsessions) that are experienced as intrusive, unwanted, and distressing, that are typically of a bizarre and irrational nature. In an effort to suppress or neutralize the thoughts, images and/or impulses, behaviors (Compulsions or rituals) are created in an attempt to experience relief by neutralizing the fear. Unfortunately, the compulsions only serve to temporarily reduce the anxiety which then leads to further compulsions. OCD can take on many forms and it is important to note that there is no typical way in which this condition manifests. Common examples include the following: Fear of harming self or others; Fear of blasphemy/sin (upsetting a higher power, usually God); Fear of becoming a child molester; Fear of becoming contaminated by urine, feces, germs, dirt, and so forth; Fear of going crazy; Fear of becoming pregnant; Fear of not doing a particular act perfectly; Fear of throwing up/getting sick; Fear of having a medical illness; Fear of acting out impulsively or in a sexually inappropriate manner; Fear of becoming gay; and Fear that something bad will happen to a loved one. While there are many more ways in which OCD can take form, these are some of the more frequent ones experienced. OCD is the most common anxiety disorder in the United States.
Social Anxiety Disorder (Social Phobia)
Social Anxiety Disorder (SAD) is a fear of being in social situations in which the person anticipates that they will be judged, scrutinized, negatively evaluated or criticized by others, or do something embarrassing in public that will draw unwanted attention toward them. As a result, one will avoid the situations producing the anxiety, which typically results in increased isolation and depression. Individuals struggling with SAD will often times make educational, relational, or career decisions based on the anxiety they experience in social situations. For example, avoid going to college and attending on-line instead; joining dating chat rooms rather than meeting in person; or becoming a computer programmer where one might be able to work our of their home. SAD is the second most common anxiety disorder.
Panic Disorder occurs when one has recurrent, unexpected panic attacks that can strike suddenly and out of the blue, which produce an experience of terror. On other occasions, the panic attacks can occur at situationally predisposed situations where a person may feel trapped. Examples include driving over a bridge; riding in an elevator; riding in a car; being home alone without help should a panic attack occur; being in small, enclosed places; standing in line; and being in a crowd. The attacks produce a number of physiological symptoms which may include some of the following: pounding heart, sweating, shaking, trembling, sensations of shortness of breath, feelings of choking, derealization (feelings of unreality), depersonalization (being detached from one-self), nausea or abdominal distress, and/or a fear of losing control or going crazy. The tendency for a person struggling with panic disorder is to avoid those situations, which refers to agoraphobia. This is the third most common anxiety disorder facing Americans.
Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD) is excessive worry about everyday events, situations, and/or activities (work, school, relationships, activities, and so forth). Typically, the person finds it difficult to control the worry and the anxiety they experience begins to interfere with their ability to focus and concentrate. Examples of the daily worry may include the following: Excessive worry about the safety of their child while they are at school; worry about whether the check will be received by the credit card company in time; worry that their spouse will divorce them; worry about the safety of their animals while they are at work; and worry about performance at work or school. Individuals will tend to ruminate about these fears and worries, which in turn tends to perpetuate the anxiety.
Post-traumatic Stress Disorder
Post-traumatic Stress Disorder (PTSD) occurs when a person has exposure to actual or threatened death, serious injury, or violence in one or more of the following ways: Directly experiencing the traumatic event; witnessing in person the event(s) as it occurred to others; learning that the traumatic event(s) occurred to a close family member or close friend; or repeated or extreme exposure to aversive details of a traumatic event(s). The individual may experience recurrent and distressing memories or dreams of the event, flashbacks, psychological distress, depression, anxiety, loss of interest in pleasure activities, isolation, and irritability. Avoidance of any contact of people, situations, or memories associated with the event is common, in addition to hypervigilance, exaggerated startle response, problems in concentration, and sleep disturbance. Examples of situations that can lead to PTSD include someone feeling threatened either verbally or physically, being attacked by another person or animal, robbed, witnessing or being involved in a serious car accident, or losing a loved one.
Specific Phobia is an excessive fear, either in the presence of an object or situation, or anticipation of the object or situation, that produces and extreme amount of anxiety. As a result, an individual will go to great lengths to avoid coming in contact with the feared object or situation. Common phobias include fear of flying, fear of heights, fear of dogs, cats, birds, and snakes, fear of throwing up, and fear of receiving an injection or coming in contact with blood.
Body Dysmorphic Disorder
Body Dysmorphic Disorder (BDD) is a preoccupation with a physical aspect or part of the body that a person feels is defective, out of place, or abnormal in some way. This defect is imagined or exaggerated, and not observable by others. This concern and distress leads them to avoid social and other situations due to fear of what people will think about them. The preoccupation and fear there is a defect can be so great that individuals will go to great lengths to correct it including surgery, Botox, and use of expensive products. Reassurance seeking from others as to whether they can see the “defect” is common. While any part of the body can be of focus, common areas include the eyes, ears, nose, mouth, cheekbones, arms, and legs.
Trichotillomania (Hair pulling)
Trichotillomania occurs when there is recurrent pulling of one’s hair resulting in a noticeable hair loss. An individual struggling with this condition typically experiences an increased sense of tension when they attempt to resist the pulling and feel a sense of relief, pleasure or gratification when the do give in. There is no experience of pain in the pulling or plucking of the hair, yet they do experience distress over the loss of hair. Reasons why people pull their hair are not entirely known however, individuals will report that the behavior is exacerbated while under stress. Often times there are specific aspects of the hair that are targeted such as a bulb, thicker or thinner hairs, or split ends. For others, there is a specific region of focus such as the scalp, back, or sides of the head, eyebrows and eyelashes, and genital regions.
Excoriation Disorder (Skin Picking)
Excoriation disorder (also known as dermatillomania) is characterized by the repeated urge to pick at one’s skin, often to the extent that damage is caused. Like Trichotillomania, an individual does not typically experience pain while engaging in this behavior and will frequently experience an increase in tension and anxiety when they attempt to resist the picking. The most commonly picked region is the face however, other locations include the chest, fingernails/toenails/cuticles, back, lips, and scalp. Most people will use their fingers to pick although it is not uncommon for individuals to use other means such as tweezers, needles, and even paperclips.
Selective Mutism occurs when a child consistently fails to speak in specific social situations, despite being able to speak in others. A common example is one who can actively engage in conversation among family members, but not while at school or around their peers. Typically this is diagnosed once the difficulty has been present for over a month.
Disinhibited Social Engagement Disorder (DSED)
Disinhibited Social Engagement Disorder is a pattern of behavior in which a child actively approaches and interacts with unfamiliar people, typically adults. Examples include approaching strangers and striking up conversations, sitting on the lap of a person who is unfamiliar to them, venturing away from caregivers, and a willingness to leave with strangers with little or no hesitation. This is a newly added diagnosis to The DSM V and little is known about it. This condition is believed to lessen as the child grows developmentally.