Generalized Anxiety Disorder

Worries are thoughts that produce distress and anxiety.  The specific thoughts however change from day to day.  Generalized Anxiety Disorder (GAD) is characterized by excessive worry about everyday things such as family and work or school.  This worry occurs more days than not for at least 6 months.  Individuals often find that the anxiety experienced is difficult to control and that it has related physical symptoms which include fatigue, restlessness, difficulty concentrating, muscle tension and sleep disturbance.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is characterized by persistent thoughts, impulses, ideas or images (obsessions) that intrude into a person’s thinking which cause excessive worry and anxiety and actions or thoughts (compulsions) performed in response to obsessions in order to relieve or prevent anxiety.

Common Obsessions include:

• Worries that one’s thoughts will cause harm to self or loved one
• Fear that something bad will happen if something is not done correctly
• Constant worries about contamination
• Ruminations about injuring self or another person
• Fear of throwing away something important

Common Compulsions include:

• Checking and re-checking items such as the door to make sure it is locked
• Washing or cleaning repeatedly
• Ordering items in a certain way
• Repeating phrases, thoughts or images
• Hoarding useless items such as old newspapers

The difference between OCD and addictions is that obsessions and compulsions are for the most part unwanted and unpleasant and only done to reduce discomfort and worry.  Most individuals realize that the thoughts and behaviors are irrational, yet they feel powerless to prevent them.  On the other hand, addictions bring anticipation of pleasure or satisfaction.

Common types of OCD include: Contamination OCD, Harm OCD, Relationship OCD, Checking OCD, Sexual Orientation OCD, Health OCD and Postpartum OCD.  These are just different categories used to describe the obsessions people are experiencing.  No matter the type of obsession, all OCD can be treated using the same skills.  We use exposure and response prevention (ERP) to treat all subtypes of OCD.

Compulsive Hoarding

As of 2013, Compulsive Hoarding has been separated from OCD according to the DSM 5.  Compulsive hoarding is a disorder characterized by difficulty discarding items that appear to most people to have little or no value.  This leads to an accumulation of clutter such that living and workspaces cannot be used for their intended purposes.  Hoarding is a difficult problem to treat. Neither medicine nor psychological therapies that work well for OCD seem to be as effective for treating hoarding.  Successful treatment focuses on cognitive therapy and behavioral practice for OCD, skills training for dealing with acquisition as well as discarding of items and the disorganization that often accompanies hoarding.

Panic Disorder

Panic attacks are discrete periods in which there is an onset of intense terror associated with feelings of impending doom.  These attacks often seem to come on with no apparent reason. Symptoms during these attacks include shortness of breath, heart palpitations, chest pain, nausea, choking sensations, chills, depersonalization and a fear of dying or going crazy.  There is also an intense fear of the panic attack occurring again.

Agoraphobia

Some individuals who experience Panic Disorder avoid places or situations where they have experienced a panic attack before, in anticipation of it happening again.  They often avoid public places where escape may be difficult in times of extreme anxiety.

Social Anxiety Disorder (SAD)

Social Anxiety Disorder is characterized by persistent fear in social or performance situations.  The individual has an excessive fear of being scrutinized and evaluated negatively by others in the social environment.  As a consequence, they may avoid situations in which their behaviors may be examined.  Such situations include: making phone calls, speaking in public and eating in public.  Physical symptoms that may accompany the anxiety include: sweating, blushing, heart palpitations and nausea.

Paruresis

Paruresis is also known as Shy Bladder Syndrome.  It is a type of social anxiety characterized by the difficulty or inability to urinate in the presence of others or perceived presence of others, whether at home or in public.  Parureiss affects about 7% of the population.

Specific Phobia

Specific Phobia is characterized by the persistent fear elicited by both the presence and the anticipation of a specific object or situation.  Like Social Anxiety Disorder, the anxiety is so intense, the feared stimulus is often avoided.  Common phobias including: flying, heights, driving, elevators, dental or medical procedures, animals and insects.

Illness or Health Anxiety

Illness Anxiety, what was formerly referred to as Hypochondriasis or Health Anxiety is characterized by having an irrational fear of getting or having a serious medical condition. Usually no symptoms are present, or if there are symptoms present it is often a normal physiological sensation (like dizziness) or a bodily discomfort (like burping or a headache). The person believes there is something wrong, even if they have received medical reassurance.

Somatic Symptom Disorder is characterized by having one or more somatic symptoms that are distressing.  Like with Illness Anxiety, the symptoms sometimes represent normal bodily sensations or discomfort that does not generally signify serious disease.  It is based on an individual’s misinterpretation of symptoms and exists despite reassurance from medical doctors.

Examples of Illness Anxiety and Somatic Symptom Disorder include:

• Belief that having diarrhea means the person has HIV
• Worry that a headache means you have a tumor
• Belief that a hand tremor is a sign of Parkinson’s Disease

Individuals may participate in compulsive behaviors including:

• Conducting internet searches about symptoms
• Contacting hotlines or the CDC to ask about risks
• Having repeated unnecessary tests including MRIs, CAT scans, and Blood tests
• Seeing multiple doctors for the same alleged symptoms
• Repetitive checking of symptoms including taking ones temperature, blood pressure or pulse

Tics/ Tourette Syndrome

Tics are involuntary, repetitive movements and vocalizations.  It is a childhood-onset neurological condition that may be referred to as Tic Disorder, Tourette Syndrome, or Persistent Motor or Vocal Tic Disorder.  The disorders are named based on the types of tics present (motor, vocal, or both) and the length of time tics have been present.

Body Focused Repetitive Behaviors (BFRBs)

Body Focused Repetitive Behaviors is the collective term used to describe related disorders including hair pulling (Trichotillomania), skin picking (Dermatillomania or Excoriation), nail biting disorder, cheek and lip biting, nail picking, and other self-grooming related behaviors.

Body Dysmorphic Disorder

Body Dysmorphic Disorder involves a disturbed body image.  Individuals are extremely critical of their self image despite the fact that there may be no noticeable disfigurements in their physical appearance.  They experience difficulty controlling negative thoughts about their appearance.  Individuals become so obsessed with their “disfigurement” that they often turn to corrective surgery.  Symptoms include: compulsively checking mirrors or other reflective surfaces, or avoiding mirrors altogether, reassurance seeking from friends and family, compulsive skin touching to feel the perceived disfigurement, excessive grooming behaviors, obsession with plastic surgery, and social withdraw or depression.

Post Traumatic Stress Disorder (PTSD)

Post Traumatic Stress Disorder is a condition that occurs in people who have experienced or witnessed a traumatic event including a serious accident, natural disaster, death of a relative, a terrorist event, a war event or personal assault.  Individuals who suffer from PTSD feel as though they are reliving the event over and over through nightmares or flashbacks.  They often avoid places, people and activities that serve as reminders of the event.  Individuals may also become nervous, irritable, detached, or feel jumpy.  Symptoms of PTSD can appear years after the original trauma occurred.