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Anxiety Disorders and Related Conditions

Anxiety

Anxiety Disorders

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:

Although Trichotillomania and Excoriation Disorder fall under The obsessive Compulsive Disorder category, the are considered to be Body Focused Repetitive Behaviors (BFRB’s), which are very specialized treatment modalities that respond best to Habit Reversal Training (HRT).

Trauma and Stress Related Disorders

Anxiety Disorders

Obsessive Compulsive Disorder and Related Conditions:

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; 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.

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.

Hoarding Disorder

Hoarding Disorder (HD) is characterized by persistent difficulty discarding or parting with personal possessions, regardless of their actual value. This difficulty stems from a strong perceived need to save items and significant distress associated with discarding them. As a result, individuals with HD tend to accumulate large quantities of possessions that clutter and obstruct living spaces, preventing their intended use. These behaviors lead to clinically significant distress or impairment in important areas of functioning, including social, occupational, and daily living activities.

Below is a description of the anxiety disorders listed above.

Panic 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.

Agoraphobia

Agoraphobia is characterized by an intense fear of situations where escape may be difficult or help might not be available. Individuals with agoraphobia often avoid public places, crowds, or even leaving their homes due to fear of experiencing distressing symptoms. There tends to be a marked fear or anxiety about two or more situations, actively avoiding these situations, and avoidance of the feared situations will tend to perpetuate the fear and avoidance.

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.

Social anxiety disorder

Social anxiety disorder (SAD) occurs when an individual has a persistent fear of social or performance situations where one might feel judged or scrutinized by others. There is astrong fear about what others are thinking about them leading to avoidance Individuals with SAD experience intense fear and anxiety in these situations, leading to avoidance or enduring them with significant anxiety and distress. And, the more one avoids, the greater the anxiety when anticipating the feared situation.

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.

Separation Anxiety Disorder (SAD)

Separation anxiety disorder results in excessive fear and anxiety when separated from a close attachment figure (parent, sibling, partner, or caregiver). It is more than typical worries about a loved one; it causes significant distress and interferes with daily life. This condition can impact both children and adults and goes beyond the normal developmental phases. Avoidance can be seen in refusal to go to school or work, difficulty sleeping alone, or physical symptoms such as headaches or stomachaches.

Selective Mutism

Selective mutism (SM) occurs where individuals, often children (but can be adults as well), are unable to speak in specific social settings, such as at school or with peers, while they can communicate freely at home or with close family members. This condition is not simply shyness; it is a significant anxiety disorder that can interfere with social interactions, learning, and overall development.

Specific Phobia

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.