A detailed booklet that describes the symptoms, causes, and treatments of the major anxiety disorders, with information on getting help and coping. This booklet is also for family and friends that are looking for further understanding of these disorders.

You will learn in this Booklet:

• describe the symptoms of anxiety disorders
• explain the role of research in understanding
the causes of these conditions,
• describe effective treatments,
• help you learn how to obtain treatment and
work with a doctor or therapist, and
• suggest ways to make treatment more effective.
The following anxiety disorders are
discussed in this brochure:
• panic disorder,
• obsessive-compulsive disorder (OCD),
• post-traumatic stress disorder (PTSD),
• social phobia (or social anxiety disorder),
• specific phobias, and
• generalized anxiety disorder (GAD).

You will also learn descripti

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The Definitive Resource for Trauma Survivors, Their Loved Ones, and Helpers Trauma can take many forms, from witnessing a violent crime or surviving a natural disaster to living with the effects of abuse, rape, combat, or alcoholism. Deep emotional wounds may seem like they will never heal. However, with The Post-Traumatic Stress Disorder Sourcebook, Dr. Glenn Schiraldi offers a remarkable range of treatment alternatives and self-management techniques, showing survivors that the other side of pain is recovery and growth. Live your life more fully-without fear, pain, depression, or self-doubt Identify emotional triggers-and protect yourself from further harm Understand the link between PTSD and addiction-and how to break it Find the best treatments and techniques that are right for you This updated edition covers new information for war veterans and survivors with substance addictions. It also explores mindfulness-based treatments, couples strategies, medic

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Post-Traumatic Stress Disorder For Dummies
As Dr. Mark Goulston tells his patients who suffer from post-traumatic stress disorder (PTSD), “The fact that you’re still afrai…

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On a secluded beach in North Carolina, three lonely people find hope in each other.Trish Evers is an artist and single mother, who…

Deal With the Devil Part Two
Wehrmacht Major Faust has a dangerous secret: he likes England. But it’s May 1940 and his Panzers are blasting the British Army …

So, take a deep breath and relax. Lots of us have BP Disorder, you are not alone. You will have questions and this should be one of the first – which BP Disorder do you have? There are several types of Bipolar Disorder which are characterized by the length, frequency and pattern of the manic and depressive episodes. Proper diagnosis is essential for effective treatment.

I have had the unique experience of originally being diagnosed as BP 2 and then upgraded to BP 1 ten years later.

Bipolar 1 Disorder

Those with BP 1 experience extreme manic episodes or mixed episodes (mania and depression occurring nearly every day for at least one week) and one or more major depressive episodes. BP 1 is the most severe form of the illness. Psychosis, paranoia and hospitalization are all associated with BP1. Episodic depression does not have to be experienced for a diagnosis of BP1 but it usually exists.

My own experience with BP1has included a trip to the psych ward, paranoia and the inability to work for months. Mixed episodes and suicidal thoughts were also present during my last relapse.

Bipolar 2 Disorder

Since depression is what normally sends us to the doctor, BP 2 is typically misdiagnosed as major depression. Basically, once the depression slips into hypomania, you feel so much better that it doesn’t occur to you to call the doctor or to stay on your meds. Frankly, you feel just fine – maybe even better than fine, that’s because the hypomania has taken over. The elevated moods associated with hypomania are welcomed warmly after a deep depression. Most of the time friends and family simply believe that the depression has lifted and you are back to being the life of the party. The problem is that “what goes up, must come down” and usually it’s not a level mood that shows up.

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My diagnosis of BP2 came during a deep depression that followed a wild hypomanic summer which was kicked off by anti-depressants meant to help me quick smoking. That’s right, I was given an anti-depressant to help me quit smoking and to relieve the slight depression caused by frequent migraines. It took only a couple of months and I was swinging high on Hypomania Mountain. I was running on all cylinders at work, I opened my own home business, never slept and spent a lot of time drinking (a form of self-medication that the hospital will consider abuse).

Not Otherwise Specified (NOS)

Bipolar Disorder NOS, sometimes called “sub-threshold” Bipolar Disorder, is a “catch-all” diagnosis that is used to indicate bipolar illness that does not fit into any of the formal DSM-IV bipolar diagnostic categories (BP1, BP 2, or Cyclothymia-see below). If an individual seems to be suffering from some bipolar manic and depressive symptoms but does not meet the criteria for BP1, 2 or Cyclothymia a diagnosis of Bipolar Disorder NOS (Not Otherwise Specified) is given.

Honestly, I think we’re all sort of BP NOS because I’ve never met two people with BP Disorder that have classically met all requirements of one or the other types. It seems to me that BP is really as unique as its owner. And by the way, you are the owner of the BP, it is not the owner of you.

Cyclothymia

Cyclothymia is a milder form of bipolar disorder characterized by several hypomanic episodes and less severe episodes of depression that alternate for at least two years. The severity of this illness may change over time.

Rapid Cycling

Bipolar disorder with rapid cycling is diagnosed when a person experiences four or more manic, hypomanic, or depressive episodes in any 12-month period. Rapid cycling can occur with any type of bipolar disorder, and may be a temporary condition for some people.

Confusing, isn’t it?

Be sure to discuss your diagnosis with your psychiatrist. Do your own research and write down any questions you may have and then ask them. Remember, YOU own BP and it is as unique as you are, therefore, you have to write your own owner’s manual because the best anyone else can do is give you the general information. You have the specifics and you must become self-aware to find them.

Just a note – The abbreviation for Bipolar Disorder is BP even though you might think it would be BD. BD is used for Borderline Personality Disorder. I don’t know why, just thought I’d let you know.

In Hope and Healing,
Bipolar Chick

This highly practical manual provides evidence-based tools and techniques for assessing and treating clients with generalized anxiety disorder (GAD). Proven cognitive-behavioral interventions are described in rich, step-by-step detail, together with illustrative case examples. With an emphasis on both accountability and flexibility, the clinician is guided to select from available options, weave them into individualized treatment plans, and troubleshoot problems that may arise. For those clients who do not respond well to CBT alone, the book also offers a chapter on cutting-edge supplementary interventions that have shown promise in preliminary clinical trials. Special features include a wealth of reproducible materials-over 25 client handouts and forms, assessment tools, and more-presented in a convenient large-size format.

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Overcoming Generalized Anxiety Disorder – Client Manual: A Relaxation, Cognitive Restructuring, and Exposure-Based Protocol for the Treatment of GAD (Best Practices for Therapy)
Effective protocols save time, increase the probability of obtaining good results, make it easier to train and supervise new thera…

Mastery of Your Anxiety and Worry: Workbook (Treatments That Work)
Individuals who suffer from Generalized Anxiety Disorder know that it can be extremely impairing, causing chronic tension, fatigue…

Into Fear and Back: One Woman’s Thirty Year Struggle with Generalized Anxiety Disorder (GAD) and How She Conquered it Without Prescription Drugs
This book is a journey that took nearly thirty years. When Generalized Anxiety Disorder reared it’s ugly head a fourth time, I had…

Effective protocols save time, increase the probability of obtaining good results, make it easier to train and supervise new therapists, and satisfy the needs of third parties to know that the proposed treatment follows the best available practices. Protocols are consistently formatted and organized; a detailed session-by-session treatment program that includes worksheets, homework assignments, in-session treatment exercises, and didactic material; specific assessment measures, both for the target disorder and for the overall treatment program; a treatment plan summary for managed care requirements. This protocol outlines a ten- to thirteen-session cognitive behavioral treatment for individual adults with generalized anxiety disorder. Techniques include relaxation, realistic risk assessment, problem solving, worry exposure, and worry prevention.

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Eating disorder treatment by a team of qualified professionals who specialize in the treatment of anorexia, bulimia, binge eating disorder and/or compulsive overeating is the best course of action to address and recover from disordered eating. There are many levels of eating disorder treatment available: outpatient, intensive outpatient, inpatient, residential, intensive outpatient and more.

Many excellent organizations exist that offer referrals to eating disorder treatment professionals.  Consider contacting the National Eating Disorder Association or the Academy of Eating Disorders for a list of professionals who treat eating disorders in your area.  Also, many eating disorder sufferers and families find that reviewing the online ‘virtual brochures’ offered in the Eating Disorder Specialist Library greatly simplifies their search for treatment.

If your access to professional treatment is limited, also seek out support through organizations such as Overeaters Anonymous, Eating Disorders Anonymous, and local church or community groups designed to provide support for eating disorder sufferers.

II.         Develop self acceptance through practicing compassion toward self.

Also, practice befriending yourself and offering unconditional self care and self respect.  Refuse to allow your self esteem to be determined by outside factors, but rather find your value in the content of your character and by being the uniquely wonderful person God created you to be.

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III.       Develop a positive and self nurturing internal dialogue.

Our inner dialogue with ourselves is critical to our recovery and general well being. Learn how to recognize ineffective thoughts and replace these with accurate and uplifting thoughts.

IV.       Get treatment for co-occurring disorders such as anxiety and depression

Anxiety disorders such as Obsessive Compulsive Disorder (OCD), generalized anxiety, panic disorder, agoraphobia, separation anxiety and social phobias are often co-occurring issues with eating disorders. Learn about the symptoms, treatment and etiology of anxiety disorders and recognize the importance of treating these disorders with therapy and possibly medication, when prescribed by a medical doctor.

V.        Practice mindfulness and living in the moment.

Mindfulness is the practice of becoming more aware of the present moment, rather than dwelling in the past or projecting into the future. Many find mindfulness techniques helpful in eating disorder recovery.

VI.       Listen to and honor your feelings.

Feelings matter. Our emotions give us valuable information about ourselves and our perceptions of the environment. Developing awareness of feelings and developing skills to tolerate uncomfortable feelings often go hand in hand with eating disorder recovery.

VII.      Eat well and listen to your body’s hunger and fullness signs.

Nutrition is the fuel for our body. Eating disorders often alter what was once a natural and enjoyable relationship with food and our bodies. Learn more about nutrition, intuitive eating and eating disorder recovery here.

VII.      Accept your genetic makeup and appreciate your body.

Body image is our perception of body, not only its appearance, but its functionality, health and purpose. A positive body image is essential to well being and recovery from anorexia, bulimia, and binge eating disorder.

IX.       Have a relapse prevention or correction plan.

Learn to recognize the early warning signs of relapse and develop skills and resources to prevent and/or pull oneself out of relapse.

X.        Develop faith and trust in God and let go of what you cannot control.

A common trait among eating disorder sufferers is the obsession with trying to control matters beyond our control.  This leads to fear, anxiety and the need to seek comfort inappropriately through disordered eating behaviors.

Faith in a loving, all powerful and just God is the key letting go of the people, places and things that we cannot control.  This leads to peace and well-being.  The choice is yours alone to make.  Go it alone and feel overwhelmed, or open your heart and your mind to God and seek His comfort and guidance in your life.

You deserve a good life full of meaningful and well lived days.  Begin your recovery plan today!

(Copyright © 2010 Eating Disorder Hope. All Rights Reserved.)

In this article you will learn how to help a friend or loved one cope and recover from panic attacks, by using a method called self exposure. A way for them to slowly become accustomed to the things and situations that make them uncomfortable. You will also learn how to avoid mistakes that would do more harm than good. Mistakes family and friends make with good intentions, but may only serve to have them avoid the things and situations that cause them anxiety

Learning the techniques of Exposure Therapy

You will need to learn about anxiety disorders and exposure treatment. If your friend or loved one has been diagnosed with an anxiety disorder, focus on that particular disorder. There are many good online works on exposure therapy you can read to prepare yourself to help them. I have included a brief description of Four different anxiety disorders.

Don’t feel that you can’t possibly help without being a qualified behavioral therapist. The main influences in our lives are the people around us, not the experts or professionally trained.

Is the person you want to help ready?

After learning the techniques of exposure therapy, discussing them with the person you wish to help may get them to give the techniques a try. Help cannot be forced on anybody. They must make a conscious decision of their own to accept your help and work at confronting their fears. He or she may not know the rewards of trying hard and might, consciously or unconsciously, believe that the techniques won’t work and would not be worth the effort.

The importance of trust

People don’t accept help from someone they can’t trust. If you’ve promised to help, stick to your word and take it seriously. You must prove to them that you can be trusted and relied on. Your actions are more important than what you say. If you don’t do the things you said you would, they will lose their trust in you. The person you want to help should not have to feel grateful that you actually kept your promise(this time). They may get discouraged and loose interest in trying to confront their fears.

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You will need to be unobtrusive, fully attentive and supportive. Always be exactly where they need you to be. You should never act board or complain. Remember that you’re there to help them overcome something that makes them very uncomfortable. Pushing them to hard, nagging or threatening, will more likely discourage them than increase their efforts.

Brief descriptions of some Anxiety Disorders

Social Anxiety Disorder and its symptoms

Social anxiety disorder is also known as social phobia. A person with social phobia may feel moderate to extreme anxiety in certain situations. They may be self-conscious at social events. Some of the physical symptoms of social anxiety disorder are difficulties talking, blushing, sweating, and nausea. They often feel they are being watched and judged. Somebody with social phobia may also fear embarrassing themselves in front of others. For more information on social anxiety disorder, symptoms and treatments.

Anxiety Disorder and its symptoms

Anxiety disorder is sometimes called panic disorder. Someone with anxiety disorder may have moderate to severe panic attacks. They may or may not know what triggers their fears. Some of the physical symptoms of panic disorder are heart palpitations, chest pains, dizziness, shortness of breath and stomach pains. These symptoms can be severe enough to make them think they are having a heart attack or may die.

Obsessive Compulsive Disorder (OCD) and its symptoms

Obsessive compulsive disorder is another form of anxiety disorder. A person with OCD has re-occurring unwanted thoughts that caused them to feel anxious. They perform rituals in an attempt to distract themselves from their obsessive thoughts and relief the anxiety they feel. The physical symptoms of obsessive compulsive disorder are similar to other anxiety disorders. Some of the rituals they may perform are listed below.

checking repeatedly if the doors locked
rearranging things after somebody has disturbed them
repeatedly combing their hair or checking their make up
cleaning something multiple times
counting
repeatedly washing hands

For more information on obsessive compulsive disorder, symptoms and treatments.

Generalized Anxiety Disorder (GAD) and its symptoms

Somebody with generalized anxiety disorder spends most or all of their time worrying excessively. People with GAD are extremely concerned about things some people would feel are trivial or of little consequence. Unlike with some other anxiety disorders, a person with generalized anxiety disorder don’t usually avoid situations that cause them anxiety. Some of the concerns they may have are health conditions, difficulties at work or money. The physical symptoms of GAD are similar to other anxiety disorders.

For more information on generalized anxiety disorder, symptoms and treatments.

There are several different types of abnormal, pathological anxieties, fears, phobias and nervous conditions that can occur suddenly or gradually over a span of years and one common blanket term for these illnesses is general anxiety disorder. This type of disorder may result in the impairment or prevention of normal daily routines in the patient and both anxiety as well as fear is an omnipresent emotion.

Though the term anxiety as well as fear have scientifically different interpretations, in common parlance the two terms are used interchangeably. This is so in the case of phobia which is another form of anxiety and can be defined as being fear that persists or is irrational and fear is defined as an emotional as well as physiological reply to external threats as they are perceived by the patient and such external threats may be a crash that is about to take place or a runaway car.

Types of Disorders

The different types of general anxiety disorders include panic disorder, agoraphobia, social general anxiety disorder (social phobia), specific phobia or simple phobia, generalized general anxiety disorders, obsessive compulsive disorder and post-traumatic stress disorder. The panic disorder relates to experiencing periods of fear that is very intense or is a psychological distress that comes about abruptly and lasts as little as half an hour and common symptoms are trembling, shortness of breath, palpitations of the heart, sweating, nausea, dizziness and hyper-ventilation as well as tingling sensations and also a feeling of being choked.

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Social general anxiety disorders are an experiencing of fear, apprehension or worry in respect to certain social situations as well as being worried about how they are perceived or evaluated by other people. This is a psychiatric disorder and the patient needs psychiatric treatment. Specific phobia occurs when there is any type of general anxiety disorder that can be thought of as being unreasonable or an irrational feeling of fear that is caused by being exposed to definite objects or situations. The affected person is prone to actively avoiding direct contact with the object or situation.

General anxiety disorder is a condition which has the characteristics of excessive as well as uncontrollable worrying about normal everyday activities. There is a disproportionate intensity as well as duration of these forms of general anxiety disorders in relation to the actual source of worry and causes the patient to have his or her daily life disrupted.

While obsessive-compulsive disorder is really a psychiatric disorder and more specifically an general anxiety disorder that manifests itself in a number of different ways but is mainly linked to obsessive thinking as well as related compulsions that are used to counteract the fixation. Finally, the post-traumatic stress disorder is an general anxiety disorder that is caused by exposure to or confrontation with stressful experiences, which are considered highly traumatic by the patient.

An general anxiety disorder can, in most cases be debilitating and that too, chronically and may begin at a young age or may suddenly be triggered after a triggering event occurs. However, there are many drugs that can be used to treat it, so hope is not lost for patients of general anxiety disorders.

Into Fear and Back: One Woman’s Thirty Year Struggle with Generalized Anxiety Disorder (GAD) and How She Conquered it Without Prescription Drugs
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The 10 Best-Ever Anxiety Management Techniques: Understanding How Your Brain Makes You Anxious and What You Can Do to Change It
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Overcoming Generalized Anxiety Disorder: Therapist Protocol (Best Practices for Therapy Series)
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Many people who develop panic disorder probably have a genetic or other biological vulnerability to the disorder.  Panic disorder runs in families (Foley et al., 2001; van den Heuvel, van de Wetering, Veltman, & Pauls, 2000).  This does not mean, of course, that panic disorders are entirely hereditary, in that family members live in the same environment.  However, the results of twin studies provide firmer evidence for an inherited predisposition for panic disorder.  Recall that identical twins share the same heredity; thus, if a disorder is transmitted entirely genetically, when one identical twin suffers from the disorder, the other twin should be highly likely to suffer from the disorder.  In contrast, fraternal twins are no more alike genetically than ordinary siblings, so that when one twin suffers from the disorder, the other twin should not be a greatly increased risk for the disorder.   Twin studies have shown than an identical twin is twice as likely to suffer panic disorder if the other twin does than is true for fraternal twins (Kendler, Neale, Kessler, & Heath, 1992, 1993; van den Heuvel et al., 2000). 

One characteristic that may be inherited in people who are prone to panic attacks is an overreactive fight-or-flight response (McNally, 2001).  A full panic attack can be induced easily by having such individuals engage in activities that stimulate the initial physiological changes of the fight-or-flight response.  For example, when people with panic disorder purposely hyperventilate, breathe into a paper bag, or inhale a small amount of carbon dioxide, they experience an increase in subjective anxiety, and many will experience a full panic attach (see Figure 15-1)  Bourin, Baker, & Bradwejn, 1998; Craske & Barlow, 2001).  In contrast, people without a history of panic attacks may experience some physical discomfort while performing these activities, but they rarely experience a full panic attack.

Figure 15-1
Panic Attacks of Patients and Control
People with panic disorder are much more likely than people without panic disorder to have a panic attack when made to hyperventilate or inhale small amounts of carbon dioxide in laboratory experiments.

This overreactive fight-or-flight response may be the result of deficiencies in areas of the brain that regulate this response, especially the limbic system (Deakin & Graeff, 1991; Gray, 1982; Reiman, Lane, Ahern, Schwartz, & Davidson, 2000).  Some studies show that people with panic disorder have low levels of the neurotransmitter serotonin in the limbic system and other brain circuits involved in the fight-or-flight response (Bell & Nutt, 1998).  Serotonin deficiencies cause chronic hyperactivities of these areas of the brain, putting the individual on the verge of a panic attack most of the time.

An overreactive fight-or-flight response may not be enough to create a full panic disorder, however.  Cognitive behavioral theories of panic and agoraphobia suggest that people who are prone to panic attacks tend to pay very close attention to their bodily senssations, misintrepret bodily sensation in a negative way, and engage in atrophic thinking (Bouton, Mineka, & Barlow, 2001; Clark, 1988; Craske & Barlow, 2001).  In the case described earlier, when Hazel felt her muscles tightening, she began thinking, “I’m having a heart attack!  I’m going to die!”  Not surprisingly, these thoughts increased her emotional symptoms of anxiety, which in turn made her physiological symptoms worse – her heart rate increased even more, and her muscles felt even tighter.  Interpreting these physiological changes catastrophically led to a full panic attack.  Between attacks, Hazel is hyper vigilant, paying close attention to any bodily sensation.  Her constant vigilance causes her autonomic nervous system to be chronically aroused, making it more likely that she will have another panic attack.

How does agoraphobia develop out of panic disorder?  According to the  cognitive-behavioral theory, people with panic disorder remember vividly the places where they have had attacks.  The greatly fear those places, and that fear generalizes to all similar places  By avoiding those places, they reduce their anxiety, and their avoidance behavior thus is highly reinforced.  They may also find that they experience little anxiety in particular places, such as their own homes, and this reduction of anxiety is also highly reinforcing, leading them to confine themselves to these “safe” places.  Thus, through classical and operant conditioning, their behaviors are shaped into what we call agoraphobia.

What evidence is their for this theory:  Several laboratory studies support the contentions that cognitive factors play a strong role in panic attacks and that agoraphobic behaviors may be conditioned through learning experiences (McNally, 2001).  In one study, researchers asked two groups of patients with panic disorder to wear masks through which they would inhale slight amounts of carbon dioxide.  Both groups were told that, although inhaling a slight amount of carbon dioxide was not dangerous to their health, it can induce a panic attack. 

One group was told that they could not control this amount of carbon dioxide that came through their masks.  The other group was told that they could control how much carbon dioxide they inhaled by turning a knob.  Actually, neither group had any control over the amount of carbon dioxide they inhaled, and both groups inhaled the same amount.   Eighty percent of the patients who believed that they had no control experienced a panic attack, but only 20 % of those who believed that they could control the carbon dioxide had an attack.  These results clearly suggest that beliefs about control over panic symptoms play a strong role in panic attacks (Sanderson, Rapee, & Barlow, 1989).

In a study focusing on agoraphobic behaviors, researchers examined whether people with panic disorder could avoid having a panic attack,  even after inhaling carbon dioxide, by having a “safe person” nearby.  Panic patients who were exposed to carbon dioxide with their safe person present were much less likely to experience the emotional, cognitive, and physiological symptoms of panic than panic patients who were exposed to carbon dioxide with their safe person present (see Figure 15-2; Carter, Hollon, Caron, & Shelton, 1995).  These results show that the symptoms of panic become associated with certain situations and the operant behaviors such as sticking close to a “safe person” can be reinforced by the reduction of panic symptoms.

Figure 15-2
Panic Symptoms in Panic Patients With and Without a Safe Person Available
Panic patients were much more likely to show symptoms of panic when a sfe person was not with them.

Figure 15-3
A Vulnerability-Stress Model of Panic and Agoraphobia
A combination of biological vulnerability to an overreactive fight-or-flight response plus cognitive vulnerability to catastrophizing cognitions may begin a chain of processes leading to panic and agoraphobia.

The biological and cognitive-behavioral theories of panic disorder and agoraphobia thus can be intergrated into a vulnerability-stress model (Craske & Barlow, 2001; see Figure 15-3).  People who develop panic disorder may have a genetic or biochemical vulnerability to an overreactive fight-or-flight response, so that even with only a slight triggering stimulus, their bodies experience all the physiological symptoms of the response.  For a full panic disorder to develop, however, it may be necessary for these individuals to also be prone to catatrophizing these symptoms and worrying excessively about having panic attacks.  These cognitions further heighten their physiological reactivity, making it even more likely that they will experience a full fight-or-flight response.  Agoraphobia develops when they begin to avoid places that they associate with their panic symptoms and confine themselves to places where they experience less anxiety.  This vulnerability-stress model has led to exciting breakthroughs in the treatment of panic disorder and agoraphobia, which we will discuss in Chapter 16.

Chapter 14
Psychological Reactions To Stress
Understanding Panic Disorder And Agoraphobia

Atkinson & Hilgard’s
Introduction To Psychology
14th Edition

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Have you ever been half-way to work and couldn’t remember turning off the iron? You know you did-you always do-but you’re not 100 percent positive you turned it off this morning. You know you’ll worry all day if you don’t go back and check. So you head home. Of course, the iron was off.

If you’ve had this kind of feeling, you get a slight idea of what people with Obsessive Compulsive Disorder (OCD) experience.

OCD is an anxiety disorder. Although it occurs less frequently in the general population than the other anxiety disorders, it can be far more debilitating and can last for decades. Between 1.6 percent and 3 percent of adults suffer from an OCD. Recent research shows a slight increase in the prevalence of the disorder. Rather than meaning more people experience it, the increase is probably because with the development of new treatments, people with OCD are now more willing to admit their symptoms.

Obsessions are ruminations or thoughts that insistently intrude into the mind against a person’s will and continue to reoccur despite all efforts to stop them. The thoughts often are worries about becoming contaminated, harming others or self, or going against some social or religious taboo such as making inappropriate sexual advances in public or swearing against God.

Often associated with these obsessive thoughts are compulsive rituals. Compulsive rituals are repetitive actions that people feel compelled to carry out against their better judgment. They usually realize these actions are irrational, but know if they don’t complete the rituals, they’ll feel anxiety and discomfort.

The symptoms of OCD usually begin in adolescence and young adulthood and affect males and females equally. Males develop the disorder earlier, between age 5 to 15, while females develop the disorder later, between age 26 to 35. The symptoms can set in gradually over years or suddenly in a few hours. Some people have episodes of varying lengths and then the symptoms will completely clear up.

Some evidence shows that responding to life experiences with obsessive compulsive behavior is inherited. The disorder can run in families and across generations. At other times, people who have OCD have no other family members who suffer from the disorder.

Research also shows that the disorder involves abnormal metabolism of serotonin, a neurotransmitter. The areas of the brain involved include the front part of the brain and the caudate structures, which serotonin neurons richly supply. It is not, however, clear whether these alterations in serotonin cause OCD or whether OCD would cause these changes in the brain.

In OCD, there are five forms of ritualizing: cleaning, checking, hoarding, orderliness, and repeating. A person with OCD can have several of these behaviors, but cleaning and checking are the most common. Cleanliness and orderliness are virtues, but when they totally control a person’s life, they are part of an obsessive compulsive disorder. Washers are more common with women and checkers are equally prevalent among women and men.

Ritualistic washers or cleaners avoid “contaminates” if possible. If they think they’ve become contaminated, they will engage in prolonged and ritualistic washing or cleaning. These rituals may last for a few minutes or continue for an hour or more. They may wash their hands 100 or more times a day. They may avoid touching door knobs or being touched by other people. They may wear gloves or long-sleeved clothing even on a hot summer day. If they are touched or touch something “contaminated,” they will immediately wash their clothing and shower for several hours.

Ritualistic checkers’ fear focuses more on future harm or danger. They worry that death, some disease, or disaster may happen to them or someone close to them. They check to avoid these dangers. They may retrace their route in a car many times, looking to see if they hit anyone or they will repeatedly call the police to find out if an accident has been reported. If they fear fires, they may repeatedly check their stove or other appliances.

Other checkers may be concerned about orderliness or hoarding. Checkers will insist on doing tasks in a particular order and completing them without interruptions otherwise they must begin the ritual again. Checkers will arrange everything in its proper place. They may have all their clothes arranged by color and have every hanger the same distance from the next. Hoarders fear throwing items away. They may have to check an empty cereal box 20 times before they can throw it away. They may pick up articles off department store floors or in parking lots. Hoarders also may have collections of old newspapers or strings.

Repeating ritualizers will do tasks by numbers. They do a ritual a certain number of times or in multiples of certain numbers. They may, for example, screw on the toothpaste cap and then count to 50. They may brush their hair 30 times. Some are greatly distressed by the time and energy they consume in doing their rituals. One man did not want to eat or drink because he did not want to use the bathroom and endure his long and extensive cleansing rituals.

Sometimes rituals are related to their morbid thoughts such as unacceptable ideas about sex or violence. They may constantly check for their spouse’s faithfulness or constantly seek reassurance of their spouse’s faithfulness. If they have thoughts of harming themselves or others, they may hide knives or avoid being around people.

Some people with OCD show no outward rituals. They only have obsessions. I once asked a woman suffering from OCD what she obsessed about. She said she obsessed about everything from the moment she got up in the morning until she went to bed.

While not complicated by rituals, these thoughts can evoke intense anxiety. The obsessions are often unacceptable thoughts such as blasphemy against God or the desire to harm others. Others use thoughts ritualistically to reduce anxiety. They may repeat prayers to themselves or count objects in a room. They may make mental checklists.

Most people sometime in their lives will engage in such rituals or have unacceptable thoughts. These are normal. For people suffering from OCD, however, these thoughts and rituals are so extensive and time-consuming that they cannot carry on their daily lives. They also suffer severe subjective distress and disgrace because of these thoughts and endless rituals.

Some will recognize their thoughts as senseless. Others will hold the belief with such intensity that it almost becomes the truth for them. They resist treatment and lack the motivation to give up their beliefs.

The obsessions tend to increase with anxiety and decrease when a person is relaxed. When people who suffer from OCD have other stresses in their lives, they experience an increase in their obsessive thoughts and rituals. This can occur with any emotional upheaval-be it pleasant or unpleasant. Therefore, marriage, the birth of a child, or the death of a family member can all result in increased obsessive and compulsive behaviors.

People who suffer from OCD can have tremendous impact on their families. They can lose their jobs because of their OCD. Sometimes they ask family members to cooperate with their rituals or will constantly ask for reassurance such as asking a family member if they harmed anyone on their drive home. They can become angry and upset if members of the family do not cooperate or support their need to do rituals. They may ask their children to bathe often or not allow them to bring friends home. They may demand that the children stay only in one or two rooms in the house. In more tragic situations, they may not touch their children for fear of being contaminated.

As devastating as OCD can be to one’s life and to one’s family, it is treatable through medications and behavior therapy. These two methods can reduce the symptoms of OCD to varying degrees; a combination of both is most effective. Traditional psychotherapy has generally not been effective in reducing the symptoms of OCD.

Professionals prescribe antidepressants for treating OCD. (For more complete information, see the article by Philip Fox, M.D.). A person suffering from OCD should give serious consideration to trying these medications. Some people cannot tolerate the medications, and others find little benefit from them. Still others can have a dramatic reduction in their obsessive compulsive behaviors and become much more successful in applying the techniques of behavior therapy.

Behavior therapy for the treatment OCD began in the late sixties and its techniques have continued to be refined. Edna Foa and Reid Wilson give an excellent presentation of behavior therapy techniques in their self-help book S.T.O.P. Obsessing. They’ve based their book on many years of research on what have proven to be the most effective techniques in treating OCD.

There are two aspects to behavior therapy: (1) Exposure to what one is afraid of and (2) Prevention of rituals people use to reduce anxiety. By applying these two methods, people can reduce the anxiety that seems to drive the obsessive compulsive behaviors.

Exposure is essential to treating all anxiety disorders. Anxiety never goes away on its own nor do people reduce it by avoidance. People must face fear and expose themselves to the fear frequently and for prolonged periods. Gradually, the fear weakens and goes away. The technical term for this is “habituation.”

In treating OCD, people also must prevent the rituals because they use the rituals to escape from the fear. In other words, they avoid the fear by using the rituals. This, too, prevents the habituation of anxiety. Methods of avoiding the fear only result in intensifying their obsessive compulsive behavior.

To use these techniques, people must have a strong commitment to getting better and overcoming their OCD. They need to experience and go into and through the fear that they spend most of their time avoiding.

The exposure and reducing of rituals is done in gradual steps. For example if a woman showers for one hour at a time, she can gradually reduce the time to 45 minutes, then 30 minutes. She should alter the sequence of her routine such as washing her hair first rather than last. In the beginning, these changes will produce anxiety. But if she makes the changes frequently enough and long enough, her anxiety gradually goes away. She needs to work at the exposure and ritual-stopping a minimum of one hour each day.

It is most effective for people to expose themselves directly to what they fear. This involves touching something they consider contaminated or messing up their room. Sometimes people must do the exposure by fantasy because they cannot do it in reality. An example is when the people have thoughts of harming others or harm happening to them. In these situations, people write out a detailed story and then tape-record it. They would then listen to the tape repeatedly until their anxiety is reduced.

For instance, a man who fears his wife may have an auto accident if he doesn’t change his clothes 20 times a day would write a story about this happening. Then he’d listen to a recording of the story over and over until his anxiety is gone. Of course, he also would not be allowed to change his clothes during this exercise.

The technique used to reduce obsessive thinking also involves exposure. People with OCD often try to stop the thought. They want to get rid of it and not have it recur. This only increases their anxiety and-with it-the frequency of the obsessive thought. We encourage people to label the thought as simply a thought and not a reality. For example, they can say to themselves, “Everyone else uses public toilets and doesn’t worry about getting cancer.” Treatment encourages them to delay the thought and give themselves permission to think the thought later. They can say to themselves, “It is just a thought and a part of my OCD. I will think about it for half an hour at 7:00 this evening.” This gradually produces a reduction in anxiety. These people also must prevent thoughts they use to reduce the anxiety such as counting or phrases that try to undo the offensive thought.

Religious rituals and blasphemous thoughts make treatment more difficult. It is often hard for people with OCD to accept that their rituals are part of a psychiatric disorder. They condemn their thoughts as offensive to God. They feel they deserve God’s punishment and doubt their salvation. Their spiritual communities often value and affirm religious rituals such as prayer and Bible reading. Their rituals, however, are often not spiritually significant and often get in the way of normal religious experiences and beliefs. People with OCD can be so consumed with prayer that they do not go to church or they so condemn themselves, they refuse to go to church.

It is important to help them see that they have obsessive compulsive behaviors in other areas of their lives. They must understand that their OCD is what’s driving the frequency and intensity of their religious behavior. They also need to realize they are isolating only one side of their faith.

One young man engaged in much prayer to reduce his feelings of guilt about his sexual desires. The frequency of his praying disrupted his ability to work, and he was constantly haunted by doubts as to whether he was saved. His pastor confronted his doubting and pointed out the sufficiency of Christ’s sacrifice. This allowed him to give up his ritualistic praying. Without the ritualizing, his obsessive thoughts began to habituate and lessen.

It takes strength and courage to confront an obsessive compulsive disorder. Admitting a problem and then seeking professional help for that problem are the first two important steps in conquering the disorder. Those who have faced the challenge know the rewards for themselves and their families are worth the effort.

Suggested Readings:

Foa, Edna and Wilson, Reid. S.T.O.P. Obsessing. New and Revised. New York: Bantam Books, 2001.

Grayson, Johnathan, Freedom from Obsessive Compulsive Disorder: A Personalized Recovery Program for living with Uncertainty. New York. Berkley Publishing Group, Penguin Group Inc. 2003.

Hyman, Bruce M., Pedrick, Cherry. The OCD Workbook: Your Guide to Breaking Free from Obsessive Compulsive Disorder. Oakland CA. New Harbinger Publication Inc. 2005

Steketee, Gail. Overcoming Obsessive Compulsive Disorder: A Client Manual: A Behavioral and Cognitive Protocol for the Treatment of OCD. Oakland CA. New Harbinger Publications,1999.

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