Anxiety Disorders

Obsessive-Compulsive Disorder (OCD)

There are two parts to OCD: obsessions and compulsions.

Obsessions are unwanted thoughts, images, or sensations that occur repeatedly. The content of the obsessions are often frightening, gives you the feeling that something bad will happen, and leads to intense anxiety, discomfort, and fear. Essentially, it is equivalent to having a nightmare that keeps replaying in your mind like a broken record.

On the other hand, compulsions are physical or mental reactions performed to keep the bad feelings from happening. They can also provide escape from the unpleasant feeling or let you feel safe temporarily. They often feel like habits that take up an excessive amount of time. The problem is that the relief you gain after a compulsion is short-lived until the obsession returns. In time, this bond becomes stronger and more difficult to break as it develops into a vicious cycle of obsessions with corresponding compulsions.

About 1 in 100 adults in the US, and at least 1 in 200 children and adolescents are currently suffering from OCD. However, many more are undiagnosed and suffering quietly due to shame, embarrassment, or simply a lack of awareness. OCD usually begins in childhood or adolescence. It does not discriminate and can happen to anyone.

Associated Features

  • Takes up more than 1 hour per day
  • Interferes with daily activities
  • Causes the sufferer to become very upset
  • Temper tantrums or defiant behaviors in children
  • Disrupts family life with rules of what others can and cannot do
  • Demands for family members’ involvement in compulsions

Common Obsessions

  • Contamination fears of germs, dirt, illness, negative traits, etc.
  • Doubts about safety, having caused harm to self or others
  • Need for symmetry, exactness, order, having things “just right”
  • Imperfection, making mistakes, acting socially inappropriate
  • Forbidden sexual thoughts or urges
  • Inappropriate religious thoughts or moral doubts
  • Hypochondriacal fears of diseases
  • Superstitious, magical beliefs
  • Need to know, have all details of information

Common Compulsions

  • Washing/Cleaning
  • Checking
  • Repeating/Counting
  • Touching/Tapping
  • Ordering/Arranging
  • Hoarding/Collecting/Saving
  • Praying/Confessing
  • Retracing Past Memories
  • Checking for safety, mistakes, information
  • Rationalizing/Seeking Reassurance

Compulsive Hoarding

Hoarding is a complex condition that involves collecting too many items and difficulty getting rid of them, which leads to considerable clutter. Collection often occurs with sale or free items, or with random materials of limited value, such as wrappers, papers, containers, strings, etc. Sufferers have a hard time letting go, throwing away, selling, or even giving away objects that may seem useless or worthless to most people. Objects may be kept because of an emotional attachment, for their informational value, or to prevent waste. The excessive amounts of items collected are often disorganized and buried in piles to the degree of limiting the use of living spaces, which can pose safety and health risks.

Associated Features

  • Collection can include books, animals, information, random memorabilia, bodily waste, foods
  • Builds and worsen over time as amount of clutter increases
  • Information processing problems with attention, memory, categorization, and decision-making
  • Limited social contact due to embarrassment and shame
  • Friends and family members are not invited to the cluttered home
  • Minimizes or rarely realizes the seriousness of the problem
  • Negatively impacts self-esteem as well as physical and emotional health
  • Clutter results in problems with day-to-day living

OC Spectrum Disorders

Obsessive–Compulsive Spectrum Disorders are various conditions that share features with OCD, yet do not technically meet the diagnostic criteria. They have similar qualities such as repetitive thoughts and behaviors, and thus, fall within the obsessive-compulsive spectrum. However, unlike OCD, many of these repetitive behaviors are more impulsive in nature and are often acceptable to the sufferer.


An irresistible urge to repetitively pull hair out from the scalp, eyebrows, lashes, or other areas of the body. Recurrent hair-pulling occurs in a trance-like state and results in noticeable hair loss. It can occur in infants, although typical onset is late childhood to early adolescence.

Body Dysmorphic Disorder (BDD)

Recurrent, excessive concerns about a non-existent or minor flaw with a particular body part. The individual often remains dissatisfied despite seeking repetitive medical/cosmetic procedures to fix the perceived, unattractive area. It usually begins in late adolescence to early adulthood.

Tourette’s Syndrome/Tic Disorders

A neurological condition that includes repetitive motor tics and vocal tics appearing before the age of 18. Motor tics are involuntary movements such as twitching, jerking, blinking, stretching, while vocal tics involve making involuntary sounds such as grunting, barking, yelping, or cursing.

Compulsive Skin Picking (CSP)

Repetitive picking at one’s own skin to the point of causing bleeding, infections, tissue damage, or permanent skin disfiguration. Picking usually occurs with fingers and nails, however, also by biting, or using tweezers/scissors. Common areas include face, head, cuticles, arms, legs, hands, and feet. It can begin in childhood or adulthood, and affect as many as 1 in 20 people.

Social – Performance – Sports Anxiety

Social phobia also known as Social Anxiety Disorder is not simply extreme shyness. Many people experience some shyness and discomfort, especially in new situations or with unfamiliar people. However, it is generally tolerable once you warm up and relax after a while. Unlike shyness, such conditions are intolerable for people with social phobia. They find it nearly impossible to relax in social or performance settings, and feel as if everyone is watching and judging. They are extremely afraid of making mistakes, appearing foolish, feeling embarrassed, and being criticized or rejected. The lack of self-confidence of social anxiety sufferers also tend to result in poor assertiveness skills. As a result, people with social anxiety avoid certain people, places, or social events that feel unsafe. At the extreme, sufferers can be completely housebound. Social anxiety in children often interferes with academic achievement, school attendance, social hobbies, and making friends. Social anxiety disorder affects over 16 million Americans, can happen to anyone, and often starts in mid-adolescence.

Associated Features

  • Can occur in celebrities, athletes, public figures, stage performers
  • Feared situations include public speaking, demonstrating a skill, stage/athletic performances, asking questions, social gatherings
  • Unreasonable fears of possible scrutiny by others or being perceived unfavorably
  • Fear of acting in ways that will be humiliating or embarrassing
  • Anxiety in children may be expressed as crying, tantrums, freezing, or shrinking from social situations
  • Feared social or performance situations are avoided or endured with intense distress

Panic Disorder

A panic attack is a sudden surge of overwhelming fear that comes without warning. It can last a few minutes to several hours, with the first 10 minutes being the most severe. Symptoms of a panic attack can feel like a heart attack, which is why sufferers may end up in an emergency medical facility with complaints of chest pains. Other sensations include shortness of breath, pounding heart, dizziness, shaking, chills, and feeling like you’re losing control of your body, going crazy, or dying. The first attack often triggers subsequent attacks. Multiple panic attacks become panic disorder as a result of the individual learning to be afraid of the physical symptoms themselves. Children often exhibit panic attacks as extreme crying spells or temper tantrums. Agoraphobia develops when the sufferer continuously avoids places or situations where escape would be difficult if a panic attack occurs. One out of every 75 people will experience a panic attack at some time in their lives.

Associated Features

  • Palpitations
  • Sweating
  • Trembling/Shaking
  • Shortness of breath
  • Choking
  • Chest pain
  • Nausea or abdominal distress
  • Dizziness or lightheadedness
  • Derealization or Depersonalization
  • Fear of losing control or “going crazy”
  • Fear of dying
  • Tingling in fingers or toes (“pins & needles”)
  • Sudden chills or hot flashes

Medical – Dental – Specific Phobias

People with a phobia are deathly afraid of a specific object or situation, and make attempts to avoid it at all cost. The anxious reaction is so strong that it can result in a panic attack. Even the thought of or being near the dreaded fear triggers intense anxiety, and is anticipated with terror. Although you may recognize that the fear is excessive, the feared object or situation is still intolerable. Some common phobias in children include insects, animals, blood, injections, doctors, dentists, elevators, moving vehicles, clowns and other odd looking people or characters, thunder and lightning, choking, vomiting, natural disasters, nighttime, and monsters. Phobias affect about 6.3 million Americans, and typically begin in childhood.

Associated Features

  • Medical/dental fears include blood, medical/dental procedures, needles, surgery, hospitals, medical personnel
  • Deters sufferers from getting the medical and dental attention they need until they are in severe pain
  • Fears of natural environment include heights, water, sun, natural disasters, storms
  • Situational phobias include elevators, planes, closets, crowds, enclosed places
  • Anxiety in children may be expressed as crying, tantrums, freezing, or clinging
  • Phobic situations are avoided or endured with intense anxiety

Eating Disorders

The category of Eating Disorders includes Anorexia, Bulimia, Binge-Eating, and Emotional Compulsive Overeating. Having an Eating Disorder is much more than just being on a diet. An Eating Disorder is an illness that permeates all aspects of your life, and is caused by a variety of emotional factors and influences. It is a reaction to low self-esteem and a result of ineffective coping skills. Between 4% and 20% of young women and men practice unhealthy patterns of dieting, purging, and binge-eating. Eating Disorders commonly co-occur with Obsessive-Compulsive Disorder, Depression, Panic Disorders and other anxiety disorders. In addition, people suffering from Eating Disorders may also exhibit other addictive or self-destructive behaviors.

Associated Features

  • Dramatic weight loss or gain within a short period of time
  • Preoccupation with food and cooking
  • Obsession with weight (even if “average” weight or thin)
  • Chronic dieting on a variety of popular diet plans
  • Obsession with calories and fat in food contents
  • Visible food restriction and self-starvation
  • Visible bingeing and/or purging
  • Use or hiding use of diet pills, laxatives, ipecac syrup, or enemas
  • Self-defeating statements after food consumption
  • Low self-esteem, feelings of worthlessness, and frequent self-deprecation
  • Need for acceptance and approval from others
  • Vague or secretive eating patterns and rituals
  • Self-blame on weight as a result of failure in social or professional relationships
  • Holding the belief that life will be better if weight was decreased

Posttraumatic Stress Disorder (PTSD)

Posttraumatic Stress Disorder is a serious condition that is a result from a person having experienced or witnessed a traumatic or horrifying event where actual physical harm or threat occurred. It is not simply trauma from a past emotional wound. Most people who experience a traumatic event have emotional reactions such as shock, fear, anger, sadness, and guilt, which are common responses that often naturally go away with time. Not every traumatized person develops PTSD. On the other hand, the experience of PTSD sufferers persists, worsens, and interferes with the person’s daily life. The person may re-experience the trauma through frightening thoughts, flashbacks, or nightmares, and would make every attempt to avoid people, places, objects, or situations that are reminders of the traumatic experience. These re-experiences often lead to further feelings of anxiety, helplessness, hopelessness, isolation, emotional numbness, and/or loss of pleasure in previous enjoyments. It is estimated that about 7.8 million Americans will experience PTSD at some point in their lives, and the rate is higher for survivors of rape, ethnically/politically motivated captivity and genocide, veterans, and those whose jobs increase the risk of traumatic exposure.

Associated Features

  • Exposure to actual or threatened death, serious injury, or sexual violence
  • Involuntary re-experiencing of trauma via memories, dreams, flashbacks
  • Constant avoidance of any association to the traumatic event
  • Magnified guilt and blame of oneself
  • Persistent fear, anxiety, anger, guilt, shame
  • Inability to experience positive emotions
  • Diminished interest/participation in daily activities
  • Irritable behavior, angry outbursts, verbal/physical aggression
  • Reckless, self-destructive behavior
  • Hypervigilance, exaggerated startle response
  • Problems with memory, concentration
  • Trouble falling or staying asleep

Separation Anxiety Disorder

It is normal for toddlers to be clingy and fear unfamiliar people and places. When brief separation is developmentally appropriate for a child, yet s/he displays excessive fear, the child may have separation anxiety disorder. The child is very attached to a parent or caregiver, and becomes extremely anxious when separated or being away from home. The child frequently worries that something bad will happen to him/her or the caregiver when separated. Even the thought of future separation causes intense nervousness that can lead to physical symptoms, such as stomachaches, nausea, and headaches. School refusal is often a result of the child’s fear of separation.

Associated Features

  • Lacks confidence in own ability for self-care without parents
  • Repeatedly asks questions about parent’s whereabouts
  • Multiple calls from school to pick up child
  • Often sick and ends up in school nurse’s office
  • Refusal to take part in sleepovers, overnight camps
  • Resists participating in activities without a caregiver
  • Pleads or bargains to remain close to parents
  • Initially becomes clingy and results in severe crying or tantrums

Generalized Anxiety Disorder (GAD)

Worrying every now and again is normal. However, people with GAD are worried almost all of the time about various everyday activities that would be considered insignificant by others. Children suffering from GAD struggle to control their worries, which may include school, sports and other activities, peers, homework, and the overall wellbeing of themselves and loved ones. When worries are chronic and extensive, they can result in physical symptoms, such as fatigue and body aches.

Associated Features

  • Continuous feelings of tension, being on edge
  • Trouble falling sleeping or staying asleep
  • Difficulty making everyday decisions and taking action
  • Constantly thinks of negative consequences
  • Magnifies significance of various situations