Anxiety, part 3

By Alan Koenigsberg, M.D.

The last two weeks covered a high-level overview of the anxiety disorders, along with a more detailed look at generalized anxiety disorder (GAD), panic disorder and agoraphobia.

This article will review obsessive compulsive disorder (OCD), social anxiety disorder and phobias.

Obsessive compulsive disorder is a chronic condition characterized by intrusive, ruminative thoughts, called obsessions, followed by behaviors, called compulsions, intended to calm those thoughts.

Common obsessive thoughts center on time, dirt and money. Examples are excessive worrying about being late, worrying about contamination, being dirty, not being clean enough, washing in a specific routine, as well as focusing on money situations that are clearly excessive to the circumstances.

We are most likely familiar with those people who will spend an excessive amount of time calculating a tip on a restaurant bill to the exact penny, seemingly oblivious to everyone else waiting to pay and leave. This lack of awareness of the unimportance of the few pennies’ difference may be an example of obsessing.

Other examples are worrying that you may not have turned off the stove and checking over and over again; fear of contamination when you shake someone’s hand; and washing your hands until they bleed.

Far too many people confuse obsessional traits with true OCD and may perceive having this disorder as a benefit. Far from that, these folks are truly suffering and are miserable.

Having mild traits of OCD may help us, but having the disorder does not.

The compulsions can be truly disabling, as they may render the person unable to function if they are constantly washing, checking, cleaning and not seeing things in context and doing “good enough” instead of looking for perfection.

Social anxiety disorder is a condition in which people develop severe anxiety in various social situations, such as eating out in restaurants, using a public restroom, going grocery shopping and so on.

They develop a sense of severe dread that doesn’t abate until they leave. They generally do not develop full-blown panic attacks, but can transition into the state of agoraphobia, in which they are afraid to leave the house.

Phobias are discrete situations of anxiety that occur when the person is exposed to something they dread, such as insects, spiders, heights, animals, water, needles, clowns and so on. The person does not experience the anxiety when the object is not present.

A side note is that obsessive compulsive personality disorder (OCPD) is not the same as OCD. The person is afraid of losing control and tries to control others. They are not out of control themselves but fear losing control, so they attempt to assuage those fears by offering excessive advice and telling others what to do.

There is extensive preoccupation with perfection, organization and control. They tend to be rigid in their beliefs, are not flexible and may not understand how others don’t follow their advice.

They believe they mean well and are often puzzled when asked not to offer advice or tell others what to do. Their insight is often minimal into this situation, whereas in the other anxiety disorders, the person is well aware of their problem.

Many of these conditions — as with others, both in the realm of psychiatry and general medicine — have inherited or genetic predispositions. Not everyone with relatives with these conditions inherits them, nor does everyone develop these disorders, but there are clear inherited characteristics, much as with some cancers, allergic disorders, autoimmune disorders and so on.

In the last article on these conditions, I’ll focus on treatment of these conditions. We are extremely fortunate to have effective treatments for these conditions, so people can live and lead healthy, productive lives.

Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas.

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