The saying, “One man’s trash is another man’s treasure,” is applicable to those who struggle with hoarding, a type of anxiety disorder that some professionals believe is correlated with obsessive compulsive disorder.

People who hoard are not lazy slobs who refuse to clean up after themselves, despite what it might seem like to others. To people who hoard, every item in their house (or car, or office, or other space) has a purpose and is needed.

Hoarding is defined by three primary traits: the obsessive collection of objects that seem useless to almost everyone else, the inability to get rid of any of them and a resulting state of distress.

How do you know the difference between “pack rat” and “hoarder”? A pack rat collects things as well, but when they run out of room, they will throw out something they no longer need. A hoarder will make room, even if it’s in what anyone else would consider inappropriate space, such as in the bathtub or in bed.

If you have an anxious partner, you may find yourself repeating statements like the following:

“It’s fine…you can do this.”

“There’s nothing to worry about.”

“Relax–everything will work out in the end.”

Or maybe you have given up on trying to reassure your partner that worrying is not helpful, and are now using statements such as:

“Enough already! Stop obsessing!”

“You are driving me crazy with your worries!”

“How old are you? Grow up…it’s just a [snake, spider, dog, etc.]“

Depending on the approach you take, you may have figured out that anxiety can be a tenacious beast, and doesn’t usually respond well to gentle encouragement or harsh criticism. Trying to find the right balance, though, can be tricky.

So what can you do if you have an anxious partner?

It’s no secret that health insurance is expensive, and paying for mental health services can be outrageous as well. When you and your partner have a large pile of bills to pay, it can make a difficult decision to forgo mental health appointments and psychiatric medications appear–on the surface–to be easier.

No money = No care, no meds. Period. End of story. Right?

Unfortunately, you and your partner may have already discovered what happens when mental health treatment is stopped abruptly. Or if you are considering this possibility, you may be in for an unpleasant surprise.

The ramifications of not getting appropriate treatment go much further than just a depressed mood or anxious thoughts and feelings. It could result in an untimely death.

One in four Americans have an anxiety disorder, and your partner may be one of them. Anxiety symptoms show up in a lot of different ways, and for the person experiencing them, they can be really unpleasant, to put it nicely.

Many people tolerate their anxiety for many years before something makes them decide enough is enough, and they make an appointment to see a doctor or therapist.

Clients will sometimes present to their doctor’s offices with what they describe as “panic attacks,” but in reality, a better name for what they are experiencing would be “crazy worry.” I am not trying to invalidate the real discomfort that comes along with these feelings, but panic disorder has specific criteria that must be met in order to get a diagnosis.

According to the National Institute of Mental Health (NIMH), panic disorder is defined as:

People with panic disorder have sudden and repeated attacks of fear that last for several minutes. Sometimes symptoms may last longer. These are called panic attacks. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger. A person may also have a strong physical reaction during a panic attack. It may feel like having a heart attack. Panic attacks can occur at any time, and many people with panic disorder worry about and dread the possibility of having another attack.

A person with panic disorder may become discouraged and feel ashamed because he or she cannot carry out normal routines like going to the grocery store or driving. Having panic disorder can also interfere with school or work.

Panic disorder often begins in the late teens or early adulthood. More women than men have panic disorder.

Nancy’s problems with spending began when her job stress increased. As she felt more anxious and depressed, she found herself turning to shopping as a way to make herself feel better.

At first, the “high” of a new purchase would help her forget her stress, but Nancy found herself spending more and shopping more often. As the bills piled up, she found herself hiding her purchases from her partner, and feeling guilty, too.

We all spend too much money from time to time, but there are some clear signs of compulsive spending:

• Being preoccupied with shopping or spending money
• Shopping when angry, sad, or anxious
• Buying things that are not needed or too expensive for the budget
• Experiencing a “high” after a purchase, but then having a mood crash afterwards
• Having relationship and/or legal problems because of the spending behaviors

Compulsive spending has the double-edged sword of both positive and negative reinforcement. Your partner experiences positive feelings from the purchase, and also relieves the negative feelings that led to the urge to spend in the first place. This can make breaking a spending habit really difficult…but not impossible.

Imagine that you had always wanted to go on a dream vacation for your anniversary with your partner, but he is scared of flying, so realizing this dream is impossible.

Or that your partner needs a medical or dental procedure, but her fear of needles and blood is so severe, she chooses to ignore the problem instead.

Or that your partner is afraid of cats, so when you move in together, your beloved cat who has been your companion for many years has to find a new home.

Most people have things they are scared of, but when your partner’s phobia prevents you from being able to live the life you want, confusion, frustration, and anger can ruin an otherwise healthy relationship. While a person generally is not able to “just get over” a phobia, there is help.

Katy spends hours each day in front of the mirror, focused on her nose. She applies and reapplies makeup several times before leaving the house, and checks herself in her car’s mirror again before driving to her destination.

She is never satisfied that her makeup hides her “ugly” nose. Throughout the day, she feels compelled to look in the mirror again and again, and has recurring thoughts that people are staring at her “hideous nose.” She has even consulted with several plastic surgeons, only to be told there is nothing cosmetically wrong.

She is currently on the search for yet another plastic surgeon who might take her seriously and agree to perform a rhinoplasty. Her family and friends are unable to see the “flaws” Katy claims are there, and she’s missed work and social events because of her unhappiness with her nose’s appearance.

Most people have certain parts of their appearance they are not happy with, but those with body dysmorphic disorder (BDD), like Katy, take it to an extreme. People with BDD spend hours every day obsessing over “flaws” that are either very minor or non-existent. They are unable to control these negative thoughts, and are not reassured by others telling them that they look fine.

These thoughts cause severe emotional distress, and interfere with the person’s ability to function in daily life, as they need to constantly check their appearance and/or do something to try to “fix” the problem. As a result, people with BDD also often avoid going out in public in order to avoid perceived scrutiny. They fear that others will also notice the “flaws” and judge them for it.

Does that sound like your partner?

One of my three cats, CJ, has a unique purr. Her purr can be heard across the house, or over the phone by unsuspecting callers, and her sound has been compared to a pigeon or turtle dove. It’s nearly impossible not to smile when she is purring (unless it is 3 a.m., because if she wakes up, she purrs then as well!) My other two kitties like to snuggle–often at inconvenient times, such as when I am trying to type a blog post!–but there is no doubt they love me. They tend to stick especially close when they sense I am unhappy or not feeling well.

One of my colleagues at Duke, Jennifer Strauss, was featured recently about volunteer work she, her husband, and their dog, Murphy, do at a camp for children who have lost a parent, sibling or other significant person in their lives within the past two years. In the article, Jennifer discusses the connections the children make with Murphy, and how his presence seems to allow them to express feelings that may not be so easy to share with adults.

The physical and mental health benefits of having pets are numerous. If you and your partner already have pets, are you getting the most benefit? If you don’t have pets, is it time to consider getting one?

Bringing up the topic of a partner’s mental illness with family and friends can feel tricky. In some cases, it might be obvious that there is something wrong, but many mental illnesses can’t be detected from the outside. However, that doesn’t mean you and your partner don’t need and deserve support from understanding family and friends.

Asking for that support can feel uncomfortable, though, given the stigma that still exists around mental illness, and cultural perceptions that we should keep personal problems to ourselves.

Jim’s drinking was clearly out of control…he had been up for over 24 hours, and the beer bottles lying around numbered over thirty. Yet he refuses to see a counselor, saying that he “doesn’t have a problem and doesn’t need help!”

Jane’s mother, Sally, age 76, can barely make her way through her own house because of the clutter and items she has accumulated. Jane is concerned for her mother’s safety, but Sally will not allow Jane to clean the house or throw anything away. The more Jane insists, the stronger Sally’s resistance. It’s gotten to the point where Sally has told Jane she is not welcome to visit anymore, and Jane cannot figure out how to help.

Josh has not been feeling like himself for a long time now: he lost his job six months ago and his girlfriend of two years broke up with him a few weeks ago. He’s finding himself sleeping through the day and staying up all night, gaming online and looking at porn. He knows he should be job hunting, but really, he doesn’t care anymore. He’s lost 20 pounds, and when he does see his friends, they are shocked at the changes. But when they ask questions, Josh blows them off and says, “I’m fine.”

All three of these people are great candidates for therapy, but none of them will go. Why?