Professionals who specialize are better able to provide optimal service, remain up-to-date on the latest research, and have more experience in the treatment of those disorders. When a clinician narrows their focus to anxiety disorders, obsessive-compulsive and related disorders, they are able to offer more expertise and experience, which aids in better results for their patients.
Separation Anxiety Disorder – Although Separation Anxiety Disorder is most frequently diagnosed in children and adolescents, about one-fourth of cases are with adults. This disorder involves excessive fear or anxiety when someone is separated from their home or someone they’re close to, such as a parent or spouse. People with Separation Anxiety Disorder may express fear of losing a significant people in their life or a person being harmed by an illness or natural disaster.
Specific Phobia – Most of us have things that upset us or we avoid, such as spiders, scary movies, or getting a shot. These are common and normal reactions. However, for some people, specific objects or situations are so aversive that it interferes with their lives, such as avoiding certain rooms of their home, not having routine blood work, or skipping a friend’s house party because of their pets. When these fears reach this point, a person may be diagnosed with Specific Phobia. Common fears people with Specific Phobia have include animals, heights. storms, getting a shot, airplanes, and vomit.
Social Anxiety Disorder – Social situations can cause some level of stress for many of us. What if my presentation at work doesn’t go well? What if I don’t know anyone at the party other than the host? What if I have nothing in common with my friend’s new boyfriend during our double date? These are normal responses to common social situations; however, when those fears and anxiety mount, they can result in Social Anxiety Disorder. The cornerstone of this disorder is the person fearing others will judge or scrutinize them. People with Social Anxiety Disorder may worry about being perceived as stupid, lazy, or boring; having other people judge them for being anxious because they are blushing, stumbling over words, or sweating; or generally feel scrutinized when eating, drinking, or giving a speech or presentation in front of others. Again, many of us experience anxiety when speaking publicly, but with Social Anxiety Disorder the fear is significantly more distressing.
Panic Disorder – Often misunderstood, Panic Disorder is not when someone experiences panic attacks. This disorder is about a person being fearful about the physical symptoms of a panic attack, such as palpitations, pounding heart, accelerated heart rate, sweating, trembling, shaking, shortness of breath, feelings of choking, chest pain, nausea, dizziness, light-headedness, chills, numbness or tingling sensations, feelings of being detached from reality, the fear of losing control, going crazy, or dying. Frequently, when a person has Panic Disorder, they will avoid places or situations that have previously triggered panic attacks, in an effort to avoid the physical symptoms of having another panic attack.
Agoraphobia – Despite its literal translation of “fear of the marketplace,” Agoraphobia is when a person has anxiety in at least two public situations where panic symptoms may occur and without an escape from the situation. Such situations including using public transportation; open spaces, such as parking lots, marketplaces, or bridges; enclosed places, such as shops, theaters, cinemas; standing in line or being in a crowd; and being outside of the home alone. A person with agoraphobia may not want to go to places alone or that are too far from their home, as these things raise a person’s anxiety.
Generalized Anxiety Disorder – Although most everyone experiences anxiety in the course of our normal lives, some people experience excessive worry about everyday things such as finances, work, school, and relationships. This excessive worry is difficult to control, interferes with daily living, and, unlike normal anxiety, the concerns associated with Generalized Anxiety Disorder (GAD) are pervasive, pronounced, and distressing; have longer duration; and frequently occur without a trigger. People with GAD may feel restless, keyed up, or on edge; be easily fatigued; have difficulty concentrating or mind going blank. Clinicians who do not specialize in anxiety may overuse this diagnosis, using it as a “catch all,” when an individual’s anxiety doesn’t clearly fit another diagnosis.
OBSESSIVE-COMPULSIVE AND RELATED DISORDERS
Obsessive-Compulsive Disorder – OCD is one of the most misunderstood mental disorders. It’s often portrayed in the media or in Hollywood as someone who is excessively clean or needs things to be organized in a specific way, but most concerning is when it’s portrayed as a desirable personality trait, which could not be further from the truth. OCD consists of two parts – obsessions and compulsions. Everyone has intrusive, unwanted thoughts, but most of us are able to ignore them and move on. However, when we give importance or meaning to those thoughts, it can become extremely distressing, which is then identified as an obsession. In order to relieve the anxiety, disgust, or discomfort the obsessions cause, people engage in physical or mental behaviors aimed at reducing the distress, known as rituals or compulsions. A misconception of rituals is that when someone performs one it provides pleasure. There is no pleasure whatsoever with OCD. Rituals offer a temporary (sometimes only seconds or minutes) reduction of distress. There are many OCD themes, most of which are unknown to the general public, as they are rarely portrayed in the media or discussed publicly. This further highlights the importance of treatment by someone who specializes in OCD.
Body Dysmorphic Disorder – Most people have a part or parts of their body they aren’t happy with the appearance of, but Body Dysmorphic Disorder (BDD) is not about vanity. People struggling with BDD have a preoccupation with one or more perceived flaws in their physical appearance that are either non-existent or not as severe as the person thinks. This preoccupation can significantly interfere with a person’s daily life, as they many spend hours trying to hide their perceived flaws, refusing to leave their home, or avoid seeing friends and family for fear of judgement from others. Unlike most of the anxiety disorders and OCD, people with BDD may lack insight about the inaccuracy of their beliefs, which can result in people trying to convince those around them that their distress is justified. Treatment for BDD isn’t about trying to convince someone that their flaws “aren’t that bad” or nonexistent, but about living their lives in spite of the distressing thoughts and being open to the idea that their flaws may not be as prominent as they perceive them.
Hoarding Disorder – The rising in television shows focusing on people struggling with excessive clutter has led to some misconceptions about people with Hoarding Disorder. Unlike collectors, people with Hoarding Disorder typically don’t limit the categories of items they save, often holding on to items because of their intrinsic beauty, their potential usefulness, the wastefulness of discarding, and sentimentality. Some people with excessive clutter struggle with acquiring, which can include not wanting to “waste” sales, or taking other people’s damaged items, such as furniture, which they have every intention of salvaging and restoring its usefulness, but typically do not follow through. Although not all people with Hoarding Disorder struggle with acquiring, discarding is always a difficulty, regardless of an item’s actual value, purpose, or usefulness. Some people struggle with insight, standing firm in their belief that these items cannot be discarded. While many people do not seek treatment for Hoarding Disorder until their 50s or 60s, research shows that most often hoarding tendencies start before the age of 20; however, it takes years to acquire the amount of clutter that causes distress or danger, prompting an individual to seek treatment.
Trichotillomania (Hair-Pulling Disorder) – Unlike other anxiety and obsessive-compulsive related disorders, Body-Focused Repetitive Behaviors (BFRBs), including hair pulling, offer a sense of pleasure. Trichotillomania can occur on any part or parts of one’s body, including scalp, face, underarms, legs, and genitalia. Some people use their fingers while others use tweezers, but Trichotillomania is not associated with shaving, electrolysis, or laser hair treatment, and rarely with waxing. When someone is doing the hair removal themselves, it can trigger thoughts of “I got it!” or “That felt good,” and feelings of accomplishment. Aside from bald patches, hair pulling can result in skin irritation, infection, scaring, as well as feelings of embarrassment or shame, if others notice the pulling, or the negative consequences of pulling.
Excoriation (Skin-Picking) Disorder– Along with Trichotillomania, Excoriation is the most common of the BFRBs. Skin picking most frequently is done with fingers and sometimes tools such as an extractor, tweezers, or pins, and is focused at skin that looks or feels different. The picking can take place anywhere on the body and is frequently happening on more than one part of someone’s body, but most people seeking treatment are primarily concerned with face picking, as it is noticeable to others. Picking of arms, legs and feet can more easily be hidden, while the skin around nail beds is a very common place to pick for people with and without Excoriation, resulting in others paying less attention to these areas. Skin picking can cause significant damage including discoloration, scaring, infections, and lesions.
Illness Anxiety Disorder – Previously classified as OCD, Illness Anxiety Disorder, or what is often referred to as hypochondriasis, now has a separate designation. People with Illness Anxiety Disorder have a preoccupation with having or acquiring a serious illness, and may or may not have minor physical symptoms, the threat of which is overexaggerated. In the event someone is worried about developing a serious illness, such as being diagnosed with cancer, the worry is in excess to the person’s actual risk, meaning that no one wants to get cancer, but few of us have behaviors that interfere in our lives regarding this fear. Many people with Illness Anxiety Disorder will spend excessive time examining their bodies looking for symptoms or examining any changes. Some suffers will excessively visit multiple doctors to confirm their worries, while others will avoid medical professionals altogether.
TRAUMA- AND STRESSOR-RELATED DISORDERS
Postraumatic Stress Disorder – The word “trauma” is often used to describe anything that’s distressing or upsetting. However, the clinical definition is much different. A trauma is when someone is exposed to actual or threatened death (such as being mugged), serious injury, or sexual violence by direct experience (it happening to the individual), in-person witness, or hearing about one of these events that has happened to a close family member or close friend (such as hearing about a loved one escaping a burning house). Repetitive exposure to traumas, such as first responders collecting human remains or police officers repeatedly exposed to details of child abuse, can also fall into the clinical definition of trauma. Posttraumatic Stress Disorder (PTSD) occurs when following a trauma the individual has recurrent, involuntary, and intrusive distressing memories or dreams of the trauma; flashbacks or feelings of reliving the trauma; or intense or prolonged psychological distress or physical reactions at exposure to internal or external triggers that symbolize or resemble an aspect of the trauma. People suffering from PTSD attempt to avoid reminders of the trauma, and might have difficulty remembering parts of the trauma, unrealistic expectations of themselves or the world around them, blaming oneself for the trauma, diminished interest or participation in previously enjoyed activities, increased feelings of detachment from others; and persistent inability to experience positive emotions and a persistent negative emotional state. When someone with PTSD cannot avoid reminders of the trauma, they may become irritable, aggressive, reckless or self-destructive, or hypervigilant, and may experience an exaggerated startle response, problems with concentration, and sleep disturbance.
Tic Disorders & Tourette’s Disorder – A tic is a sudden and rapid movement that a person does in order to reduce an internal sensory urge, refereed to as a premonitory urge. This movement can be motoric, such as eye blinking, shoulder shrugging, facial grimacing, or neck rolling, or vocal, such as throat clearing, grunting, coughing, or sniffing. To receive the diagnosis of a Tic Disorder, a person has either vocal or motor tics, but not both. When a person has both a vocal and motor tic, the person has Tourette’s Disorder. To receive either diagnosis, a person must have first developed tics prior to the age of 18. It’s common for someone to have multiple tics, and for those to wax and wane over time. The frequency and severity of tics can increase at times of high stress and anxiety. Although new tics can develop in adulthood, it’s not common.
Depression – It’s very common for a person struggling with anxiety, OCD, or their related disorders to also experience depression. It makes sense – when a person has distress to the point of it interfering with their job, relationships, family, or friends, this will negatively impact their mood, and if the interference is significant, a person may develop depression. In these cases, when the primary concern is treated (anxiety disorder or OCD), the depression often lifts. On the flip side, when someone’s primary concern is depression, thoughts of participating in typical daily activities, performing at work or school, or social gatherings can trigger anxiety. Similarly, it’s common for the anxiety to lift as the depression is successfully treated. Treating depression concurrently with anxiety or OCD is common, with additional interventions made to help aleviate the depressive symptoms.
Panic Attacks – Having a panic attack can be extremely scary. Many people who have had one describe their first experience as feeling as if they were having a heart attack. It’s not uncommon for someone to go to the emergency room with fears of a recent heart attack, only to learn after examination and testing that it was a panic attack. A panic attack can be triggered by a situation, person, or other stimuli, or can come out of the blue, with no clear reasoning. The good news is that not only is the person not having a heart attack, but panic attacks are not dangerous. Although physical symptoms of panic attacks may vary, they often include at least a few of the following: palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath or smothering; feelings of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, light-headed, or faint; chills or heat sensations; numbness or tingling sensations;feelings of unreality or being detached from oneself.
Stress Management – Although everyone has stress, we all experience different levels of it, and are capable of handling varying amounts of it before it takes its toll. Stress can impact our personalities, energy, sleep, concentration, productivity, and, arguably the most important, our enjoyment and pleasure. Stress doesn’t just come in the form of negative situations either. Planning a wedding or packing for a vacation or preparing for a new baby are all exciting experiences, but still can take a toll. Some may believe that stress management is about cutting stress out of our lives, and when that’s a realistic option, that’s terrific. But most of us can’t afford to quit our jobs, or want to end long-term relationships, or move to a new home. In the absence of these options, it’s important to have the skills to respond to stress in ways that allow for results and effective outcomes, without overwhelming ourselves to the point of misery. If we can’t eliminate our stress, then the best option is to learn how to better respond to stressors, which is possible.