Anxiety & OCD
Anxiety is an exaggeration of the normal mental and physical sensations of fear. Anxiety can create feelings of fear, worry, and uneasiness. Anxiety also can produce physical symptoms, such as trembling, upset stomach, nausea, diarrhea, headache, chest pain, trouble breathing, irregular heartbeats, muscle tension, and sleep disturbance. These physical symptoms are particularly likely during severe anxiety or panic attacks. While everyone normally experiences some small degree of anxiety in stressful situation, it is when anxiety becomes overwhelming or one changes their daily routine to avoid anxiety-producing situations (e.g., social situations) that it can be considered an Anxiety Disorder.
Approximately 27% of Americans suffer from one anxiety disorder or another. These includes Social Anxiety Disorder, Panic Disorder, Obsessive Compulsive Disorder (see below), Separation Anxiety Disorder, Post-Traumatic Stress Disorder, and Generalized Anxiety Disorder.
Generalized Anxiety Disorder is a chronic anxiety disorder which is best characterized by excessive anxiety and worries about multiple aspects of life. The fears are often unrealistic or an exaggeration of likely events.
Panic Disorder is an anxiety disorder characterized by episodes or “attacks” of extreme anxiety with a number of physical symptoms. These can occur in the context of many of the anxiety disorders.
Social Anxiety Disorder is a chronic excessive fear of public embarrassment or being harshly judged in social situations. This can lead to reluctance to go to school, go to work, or engage in any activity that requires interacting with people outside the immediate family.
A Phobia is a specific fear of a specific object or situation. Examples include fear of spiders, water, snakes, or dogs. Agoraphobia is perhaps the most common phobia and, practically speaking, is a fear of being trapped in a situation. People with agoraphobia will almost always try to position themselves so they can quickly leave a room or situation if they feel excessive anxiety.
Obsessive-Compulsive Disorder is a particularly severe form of anxiety, but also the one with the best understood brain circuitry. The classic example of repeated handwashing is but one manifestation of a complex interplay of thoughts, feelings, and behaviors that patients with OCD experience. At the heart of OCD are obsessions (thoughts) and compulsions (behaviors). Obsessions are thoughts that create anxiety for the patient. They are often intrusive – forcing their way into a patient’s mind when the patient is relaxing, actively enjoying themselves, or concentrating on a task. These obsessive thoughts lead to anxiety. When the thoughts occur repeatedly, the patient becomes more and more anxious. The anxiety can risk to intolerable levels and then the patient must do something to relieve the anxiety. The action that the patient takes to reduce the anxiety is the compulsion. Since the obsessive thoughts increase the anxiety and the compulsion decreases the anxiety, a vicious cycle of rising anxiety and attempts to reduce the anxiety can, and often do, develop. For example, a patient has the intrusive thought that they did not turn off a stove burner leading to a fear of fire and the need to check and re-check the burner. Or a child who takes an uneven step has the intrusive (and irrational) thought that this misstep will cause something bad to happen to his mother and so feels compelled to spin around two times to the left to prevent this harmful outcome. Indeed, patients may be unaware of what they fear or of the rising anxiety. In this case, the association between the obsessive thought and the compulsive behavior has become automatic.
Trichotillomania and skin-picking are symptoms of anxiety. Trichotillomania is the repetitive pulling of one’s own hair and often can become engrained into a highly complex behavior. Patients with trichotillomania often feel a great deal of shame and attempt to hide the behavior or its resulting hair loss.
Functional neuroimaging studies have shown that there are different portions of the brain involved in different anxiety disorders. For example, most patients with OCD have overactive anterior cingulate gyri and caudate nuclei. Studies have shown that inositol and SSRI’s reduce abnormal activities in these areas. A recent imaging study showed therapy also could improve the brain dysfunction associated with anxiety. Neuroimaging also gives information to differentiate anxiety from dementia in the elderly or from ADHD in children (the nervousness, restlessness, worries, uncertainty, irritability, and trouble concentrating in anxious children often can be confused with ADHD, but these look completely different with functional neuroimaging).
Treating Anxiety Disorders
Treatments for anxiety disorders include medications, a variety of therapy techniques, physical exercise, and even certain supplements. It is important to realize that all remedies and medications have a certain degree of risk or side effects. For example, valerian root is a natural remedy often purported to help anxiety, but with daily use it can lead to bleeding disorders. Some medications for anxiety, such as the benzodiazepines, are addictive and interfere with learning and memory function. Other medications which are often prescribed for anxiety, the SSRI’s, can actually worsen anxiety in some patients. No single medication seems to be effective for all patients with anxiety disorders.
Numerous therapeutic studies have shown that the combination of medications and therapy is more effective than either alone. Different therapeutic modalities work better for different types of anxiety. Cognitive-behavioral therapy is particularly effective for OCD. PTSD responds well to Eye Movement Desensitization and Reintegration (EMDR), along with other techniques.
If you or somebody you know is suffering from anxiety or OCD please don’t hesitate to get in touch with us. We have answers and we can help. Please visit our contact us page to find out the best way to reach us.