Anxiety Disorders and Phobias

OCD is classified as an anxiety disorder.  Other anxiety disorders include Generalised Anxiety Disorder, Post Traumatic Stress Disorder, Panic Disorder (Panic Attacks),  Social Anxiety Disorders and Phobias.

Panic attacks are extremely frightening. They may appear to come out of the blue, strike at random and make people feel powerless, out of control and as if they are about to die or go mad. Many people experience this problem, and it is not uncommon for someone with OCD to experience similar feelings to panic attacks. However, many also learn to cope and eventually to overcome it successfully.

When panic attacks are experienced out of the blue without an apparent trigger, this is classified as panic disorder.

Sufferers of panic disorder often feel fine one minute, and yet the next may feel totally out of control and in the grips of a panic attack. Panic attacks produce very real physical symptoms from a rapid increase in heartbeat to a churning stomach sensation. These physical symptoms are naturally unpleasant and the accompanying psychological thoughts of terror can make a panic attack a very scary experience. For this reason, sufferers start to dread the next attack, and quickly enter into a cycle of living 'in fear of fear'.

Post-Traumatic StressDisorder (PTSD)
Post-traumatic stress disorder is another of the anxiety disorders. The psychological effects of severe traumatic experiences are well known, but it is only in recent years that the diagnostic category of post-traumatic stress disorder has been widely recognized. Essentially, this refers to a psychological disorder that some people develop after exposure to a traumatic event (e.g. war, earthquakes and fires, violence, serious motor accidents). The main features are the persistent re-living of the traumatic event—e.g. recurrent intrusive memories, recurrent dreams; avoidance of reminders of the event; and increased arousal, as illustrated by sleep difficulties, poor concentration, and so on. Large numbers of war veterans have been treated for this disorder, and there is an active and still growing interest in this area.

The recurrent, intrusive thoughts and images that occur in this disorder are similar to some of the obsessions experienced by patients with OCD. This is particularly so for the very vivid intrusive images. For example, a former soldier now suffering from post-traumatic stress disorder had the recurrent image of bloated and charred bodies. In addition to very disturbing images, sufferers tend to have intrusive thoughts other than memories of the event (e.g. 'Why did it have to happen to me?', 'Am I really safe now?'). Some also report cognitive compulsions, such as compulsively saying 'No, it wasn't my fault', or compulsively going over the incident, step by step in great detail.

In a small number of patients with this disorder, overt compulsive rituals are found. Once, a 46-year-old man who was subjected to a vicious act of violence, developed rituals of repeatedly checking door and window locks. A woman who was seriously sexually assaulted while on holiday began to wash herself compulsively in order to 'become clean'.

It is common for some of the features of obsessive-compulsive disorder and post-traumatic disorder to overlap; but are the two related? There are certainly instances in which a trauma victim develops obsessions and/or compulsions to the degree that one can describe him as suffering from obsessive-compulsive disorder. Numbers of obsessive-compulsive patients have a history of traumatic or disturbing experiences, but the two disorders have distinctive features. The majority of patients with obsessive-compulsive disorder do not have a history of trauma. Similarly, the majority of patients who suffer from post-traumatic stress disorder do not develop full-blown obsessive-compulsive disorder. A small number do, and may have both disorders concurrently. In some, the obsessive-compulsive disorder persists even after the full-blown post-traumatic stress disorder has resolved.

Phobias fall into the category of anxiety disorders, because anxiety is prominent in both of them. Sometimes obsessive-compulsive disorders are confused with phobias, which are excessive and irrational fears. With the important exception of a fear of contamination, patients with OCD do not appear to be particularly prone to develop phobias. The fear of contamination tends to be intense, spreads rapidly, is dominating, and generates widespread avoidance. This fear drives the classical symptom of the disorder— compulsive washing and cleaning.

With this exception, compulsive behaviour of the obsessive-compulsive type is uncommon in phobias. A person who has a phobia usually feels safe in his day-to-day life, if he successfully avoids the object or situation that scares him. Someone with a phobia of elevators, for example, will avoid using elevators and be able to lead an untroubled life, as long as he is not obliged to use an elevator; and someone with a phobia of spiders can lead a normal life, as long as he avoids encounters with spiders. In contrast, an obsessive-compulsive patient cannot escape from his problems as easily; even if he manages to minimise contacts with places/people that trigger his obsessions or compulsive urges, his problems are not contained. Obsessions in particular, frequently intrude at times and places that are not containable. In fact, for many patients the potential 'trigger', an intrusive thought, can emerge anytime, anywhere. For example, a woman with obsessive-compulsive disorder may totally avoid knives, scissors, and other sharp objects, which she fears she may use to attack people, but will still be tormented by thoughts that she might commit these acts, or be engulfed by self-doubts about whether or not she has already attacked someone. Fears of becoming contaminated by direct physical contact with a dirty/dangerous object (contact contamination) come closest to resembling a phobia, but the related fear of mental contamination, which often arises without any contact, is less like a phobia.

Obsessions and compulsions are more intrusive and more pervasive than phobias, and frequently interfere with daily living.

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