By: Gia Gittleson, MSN, RN
Psychiatric Nurse
Resilience Treatment Center

Anxiety is natural. Everyone has experienced some form. When we see the “check engine” light, our hands might sweat and tremble. Our pulse may elevate. Sometimes, our minds go blank during an exam. On one hand, a modicum of anxiety keeps us alert, but if the frequency and the duration of episodes rob us of a fulfilling life, levels and types of anxiety need to be addressed.

No matter the type of anxiety, our physiological responses include hypertension, shortness of breath, sweating, shaking, a pounding pulse, dizziness, the inability to think clearly, temporary memory loss, lack of sleep, decreased or increased appetite, over-eating, under-eating, stomach upset, and dry mouth.

The American Psychological Society provides various diagnoses of anxiety. Panic Disorder, more commonly known as anxiety attacks, is accompanied by a feeling of dread. Incessant worrying when there is no reason for such perseveration marks Generalized Anxiety Disorder. When we have Social Anxiety Disorder, we have difficulty holding conversations; even small talk is cause for unbearable discomfort. Phobias manifest in so many ways. Post-Traumatic Stress Disorder arises from experiences such as rape, domestic violence, natural disasters, and combat.

Let’s look at Obsessive-Compulsive Disorder (OCD) more deeply. In this diagnosis of anxiety, we need to distinguish between “obsessions” and “compulsions.” According to the National Institute of Mental Health, “obsessions are repeated thoughts, urges, or mental images that cause anxiety” while “compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought.” [1]

Basically, anyone can obsess about anything. Someone may worry about being contaminated by viruses and bacteria. We may perseverate on thoughts such as harming ourselves, hurting others, or abusing animals. Other people may need to create a home or work environment that is so orderly, untidiness makes them anxious.

Compulsions are the result of obsessive thoughts. By reacting to obsessions with compulsive, sometimes ritualistic behavior, the person may experience some relief from anxiety that the obsession has raised. Folks with a fear of germs may wash their hands or use hand sanitizer too frequently, refrain from going into the community, and avoid relationships. Some people may incessantly clean their home. Other compulsions include repeatedly checking if a door is locked or an appliance is unplugged. Some people may feel the need to count the sides of pictures, window frames, or doors. Others may take great care to not step on cracks in the sidewalk.

The National Institute of Mental Health makes the distinction if a person “spends at least 1 hour a day on these thoughts or behaviors,” the person could be diagnosed with OCD.” [2] People may logically understand that they are obsessing or behaving compulsively, but can’t banish their thoughts or actions. OCD robs people of time that could be spent relaxing, developing relationships, and enjoying meaningful work. This is where treatment comes in.

Many medications can quell anxiety. Rather than depending on addictive benzodiazepines such as Xanax, Ativan, and Valium, antidepressants and beta-blockers have been found effective. Since a deficit of serotonin may play a part in the pathophysiology of OCD, selective serotonin reuptake inhibitors are at the top of the list of pharmacological interventions: Fluoxetine (Prozac), Paroxetine (Paxil), Citalopram (Celexa), and Sertraline (Zoloft). [3] Clomipramine (Anafranil), a tricyclic antidepressant that also acts on serotonin, is also frequently prescribed for OCD. Beta-blockers treat both high blood pressure and anxiety by blocking the release of adrenaline—the hormone that’s released during our “flight or fight” response to imminent dangers. In fact, beta-blockers such as atenolol and propranolol are so effective, they have been prescribed for stage fright. [4]

In addition to medication, there are myriad non-pharmaceutical treatments. The National Alliance on Mental Health outlines evidence-based therapies, such as Cognitive Behavioral Therapy, Dialectical Behavior Therapy, Eye Movement Desensitization and Reprocessing Therapy, Exposure Therapy, and Pet Therapy. [5] These approaches all offer skills and tools, that when adopted and practiced, may yield deep-rooted, positive change.

The opportunity to reinvent oneself by learning, practicing, and refining new coping strategies isn’t always easy. This path requires commitment, curiosity, and willingness. Be gentle with yourself by acknowledging it’s normal to take one step forward and two steps back in the process of change. I like to say, “charity begins at home. And you are the home. So be kind to yourself.” By allowing yourself to recognize that you may be experiencing symptoms of OCD and anxiety is the first step. A brave step! It takes courage to say, “I need help. I want to change.”

References
[1] [2] National Institute of Mental Health. (2016). Obsessive-Compulsive Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml
[3] Stanford School of Medicine. (2016). OCD Research: Pharmacological Treatments. Retrieved from http://ocd.stanford.edu/treatment/pharma.html
[4] Tindall, B. (2004). Better Playing Through Chemistry. Retrieved from http://www.nytimes.com/2004/10/17/arts/music/better-playing-through-chemistry.html?_r=0
[5] National Alliance on Mental Health. (2016). Psychotherapy. Retrieved from http://www.nami.org/Learn-More/Treatment/Psychotherapy