Anxiety disorders

Obsessive-compulsive disorder (OCD)

People with obsessive-compulsive disorder have repetitive, intrusive thoughts that are beyond their control. These obsessions lead to ritual behaviors to try to relieve the obsessive thoughts such as the ones listed below; however, the ritual behaviors do not provide relief, as the obsessive thoughts continue to intrude. The compulsive behaviors begin to take up more and more time and end up creating more anxiety themselves.

Common obsessions include:

• Concern with dirt or germs; either being contaminated or contaminating others
• Fear of causing harm to yourself or others
• Extreme fear of making mistakes or not doing the “right” thing
• Excessive concern with order, arrangement, or symmetry
• Concern with sacrilege and blasphemy
• Intrusive nonsense sounds, words, or music

Common compulsions include:

• Excessive or ritualized hand washing
• Excessive or ritualized showering, bathing, tooth brushing, or grooming
• Repeatedly checking things, such as locks or stoves
• Collecting or hoarding items with no apparent value
• Need to touch, tap, or rub
• Need to order and arrange things in a certain way
• Need to count, mentally or aloud, while performing routine tasks
• Need to repeat routine activities
• Checking that nothing terrible has happened

The most effective treatment for obsessive-compulsive disorder is cognitive behavioral therapy, and specifically exposure and response prevention.

In exposure and response prevention, a therapist will work with you to provide controlled exposure to the source of your obsession. You are then asked to refrain from the compulsive behavior you’d perform to reduce your anxiety until the urge goes away on its own. Over time you learn to gain control over your obsessive thoughts without resorting to the compulsive behavior. Antidepressant medications are also effective, as is the combination of cognitive behavioral therapy and antidepressant medications.

Panic disorder

People with panic disorder live in fear that they will have another sudden, inexplicable panic attack: an extreme, uncontrollable sense of panic that comes on out of nowhere. Part of what is so debilitating about panic disorder is the fear of having a panic attack in a situation that would be embarrassing or where you can’t escape easily.

People with panic disorder may have some of the following reactions after a series of panic attacks:

• Avoidance. You might go out of your way to avoid where you were and what you were doing when a panic attack occurred. You might do this even if there is no pattern to your panic attacks. This can make a normal work and home life nearly impossible.
• Anticipatory anxiety. Panic disorder can involve a cycle of anxiety: a panic attack is extremely upsetting, and you become anxious about the possibility of having another one.
• Agoraphobia. This is the fear of being in places or situations where an attack may occur, or where you can’t escape. This fear might cause you to avoid public places and crowds, and may even progress to the point where you will not leave your home, or where you need a “safe person” with you to go out.
• Claustrophobia. You may fear enclosed spaces after experiencing panic attacks.

The panic attacks themselves are all-consuming while they last and can include:

• Difficulty breathing or a sensation of choking or smothering
• Pounding heart or chest pain
• Intense feeling of terror
• Dizziness or feeling faint
• Trembling or shaking
• Sweating
• Nausea or stomachache
• Tingling or numbness in the fingers and toes
• Chills or hot flashes
• A fear that you are losing control or are about to die

Panic disorder is treatable, often with cognitive behavioral therapy, antidepressant medication, or both.

Additional stress management, such as exercise, relaxation techniques, yoga, and meditation, and avoiding caffeine, drugs, and alcohol, may also be helpful. People who experience panic attacks often feel as though something is wrong with their heart. It is a good idea to see a healthcare provider to rule out physical causes of panic attack symptoms.

Phobias

Specific phobias form another group of anxiety disorders. Specific phobias are intense, irrational fears of situations that actually present little or no danger. If you have a phobia, you realize that your fear is extreme and not shared by others, but that doesn’t lessen the anxiety it produces.

People have experienced specific phobias over many situations and objects.

Common phobias can be grouped in the following categories:

• Animal phobias: dogs, snakes, spiders, insects, or mice. Animal phobias are among the most common specific phobias.
• Situational phobias: flying, riding in a car or on public transportation, being in elevators, driving, going over bridges or in tunnels, or being in a closed-in place.
• Natural environment phobias: storms, heights, the dark, or water.
• Blood-injection-injury phobias: being injured, seeing blood, or invasive medical procedures, such as blood tests or injections

Specific phobias can respond very well to treatment. The best treatment is exposure therapy, which is often effective in only a few sessions.

Social anxiety disorder

Social anxiety disorder is anxiety in social situations that goes beyond shyness. If you have social anxiety disorder, you feel anxiety in social situations and might fear that you are being watched and judged by others.

Situations that may produce anxiety:

• Meeting new people
• Eating or drinking in front of others
• Writing or working in front of others
• Being the center of attention
• Asking questions or giving reports in meetings or groups
• Using a public restroom
• Talking on the telephone
• Being watched while doing something
• Making small talk
• Public speaking
• Performing on stage
• Being teased or criticized
• Talking with “important” people or authority figures
• Being called on in class
• Going on a date
• Taking exams
• Attending parties or other social gatherings
• Interacting with strangers
• Making eye contact
• Ordering food in a restaurant
• Initiating conversations

Social anxiety disorder can respond very well to treatment, including cognitive behavior therapy and antidepressant medication. Often a combination of CBT and medication is helpful.