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People with generalized anxiety disorders (GAD) have ongoing, severe tension that interferes with daily functioning. They worry constantly and feel helpless to control these worries. Often their worries focus on job responsibilities, family health, or minor matters such as chores, car repairs, or appointments.They may have problems sleeping, muscle aches/tension, and feel shaky, weak and headachy. People with GAD can be irritable and often have problems concentrating and working effectively.
Obsessions – Obsessions are upsetting and irrational thoughts which keep reoccurring. They cause great anxiety, which cannot be controlled through reasoning. You might think “doesn’t everyone have obsessions”? Of course we all have passions about people, places and things in our lives and at times thoughts about them may dominate our thinking for awhile, but a true “obsession” is an intrusive, recurring thought, image or impulse considered to be inappropriate and/or irrational while most likely causing some degree of suffering. Obsessions are not typical concerns over stress in relationships or career.
Obsessions can manifest in many different ways, but the most common obsessions are fear of germs or of being contaminated, fear of causing others harm (hurting your child, hitting someone with your car), or of harm coming to oneself, inappropriate sexual thoughts (ex. incest), violent images, numbers, fears of being gay, etc. While these intrusive thoughts may invade consciousness, the drive behind OCD is to undo the spell of a specific obsession through performing a compulsive act.
Compulsions – Compulsions are the behavior that one engages in to reduce the anxiety often associated with an obsession. These are avoidance behaviors. Unfortunately, they become a huge barrier as they actually continue and maintain the anxiety, thereby making it worse and bound to continue over time. These behaviors can interfere with daily life due to their time-consuming nature and disruption. Some examples include extreme handwashing, checking, counting, repeating certain phrases to oneself, and many other behaviors that involve avoiding certain stimuli that trigger the anxiety.
Although OCD thoughts and rituals may be deeply ingrained, reducing compulsive behavior is key in treating OCD. There are two interventions recommended to effectively treat OCD symptoms:
CBT is based on the idea that intrusive thoughts, anxiety, and rituals are habitual ways of reacting, and because they are habits, they can be weakened utilizing a treatment known as Exposure/Response Prevention (E/RP). E/RP is a learning-based treatment that consists of a series of exercises designed to encourage acceptance of uncertainty. Exercises include:
The obsessive compulsive spectrum includes a range of disorders that vary on whether the accompanying behaviors tend to be more compulsive versus impulsive. On the compulsive side, people with OCD, for example, exhibit over-thinking, excessive worry, over-focus on unlikely consequences and harm reduction. In contrast, impulsive behaviors like those involved with eating disorders and other addictions involve numbing and under-thinking in spite of risks. Although we talk about the OCD spectrum as being linear, in reality, people may exhibit a combination of behaviors.
For more information about these disorders visit www.adaa.org.
In addition to Obsessive Compulsive Disorder, some of the Obsessive Compulsive Spectrum Disorders that I treat using Cognitive Behavioral Therapy include:
Compulsive Side of the OCD Spectrum
Health Anxiety / Hypochondriasis – Hypochondriasis, also known as health anxiety or health phobia, involves an excessive preoccupation or worry about having a serious illness or disease, even when there is no medical evidence to support the presence of an illness. If you have excessive health anxiety or hypochondriasis, you may:
Often, hypochondria persists even after a physician has evaluated you and reassured you that your concerns about symptoms do not have an underlying medical basis or, if there is a medical illness, your concerns are far in excess of what is appropriate for the level of disease.
Body Dysmorphic Disorder (BDD) – Body Dysmorphic Disorder involves an obsessive, irrational preoccupation with a defect in one’s physical appearance. You may focus on a specific bodily part, such as your hair, your nose, your stomach or your skin and believe that it is grossly disfigured, even though there’s nothing wrong with you.
Impulsive Side of the OCD Spectrum
Trichotillomania / Hair Pulling – Trichotillomania involves a recurrent, compulsive pulling out of one’s own hair, resulting in observable hair loss. You may feel a build-up of tension and feel relief when playing with or pulling out your hair. Some people report that they need to find just the right, strand of hair to pull out and may experience some enjoyment from the tactile stimulation.
Skin Picking and Nail Biting – Skin picking and nail biting become a disorder when they involve repetitive picking at one’s own skin or nails to the point that it causes damage. Compulsive skin picking often leaves visible scars and brings the sufferer intense shame, causing them to keep the affected areas covered.
The core symptom of panic disorder is the panic attack, an overwhelming combination of physical and psychological distress. During an attack several of these symptoms occur in combination:
A phobia is excessive and persistent fear of a specific object, situation, or activity. These fears cause such distress that some people go to extreme lengths to avoid what they fear. There are three types of phobias:
Specific phobia — An extreme or excessive fear of an object or situation that is generally not harmful. Patients know their fear is excessive, but they can’t overcome it. Examples are fear of flying or fear of spiders.
Social phobia/Social Anxiety Disorder — Significant anxiety and discomfort about being embarrassed or looked down on in social or performance situations. Common examples are public speaking, meeting people, or using public restrooms.
Agoraphobia — This is the fear of being in situations where escape may be difficult or embarrassing or help might not be available in the event of panic symptoms. Untreated agoraphobia can become so serious that a person may refuse to leave the house. A person can only receive a diagnosis of phobia when their fear is intensely upsetting, or if it significantly interferes with their normal daily activities.
Posttraumatic stress disorder (PTSD) occurs in individuals who have survived a severe or terrifying physical or emotional event. People with PTSD may have recurrent nightmares, intrusive memories, or flashbacks, where the event seems to be happening all over again. They feel extreme distress when in circumstances that remind them of the trauma, and go to extremes to avoid these situations. Additional symptoms include:
Events that can trigger PTSD include military combat, a violent personal attack, natural disasters, tragedies (e.g., plane crash), physical or sexual abuse during childhood, or witnessing another person’s serious injury.