Anxiety and OCD Exposed Anxiety news, insights and commentary from the authors of Anxiety for Dummies 2013-12-10T13:38:29Z Laura L. Smith, Ph.D. <![CDATA[Fish and Fear]]> 2012-05-30T00:20:11Z 2012-05-29T21:03:26Z About two years ago, we put in a fish pond in our backyard. Before that we had a soothing water feature that regularly sprung leaks, ruined our adobe wall, and made a mud bath for the dogs. That soothing water feature became an endless series of frustrating repairs. So, when two new guys came out for the umpteenth time to dig around the back yard to find the leak, we were pretty stressed out.

One guy with long hair in a ponytail drew us pictures of a tranquil spot that would never leak (he was planning on replacing the rocks with concrete). It sounded good.

About 100 days later after delays, disturbances and more and more money, the guys left. And there was a small pond with some plants and fish in it. We were so happy to get rid of the workers (for those of you who spend lots of time working at home you know what I mean), that we celebrated with a barbeque.

Most of the people at the barbeque had horror stories about their own ponds or their neighbors’ ponds that attracted all sorts of lethal insects, mold, algae, leaks,and basically trouble. So, we thought we’d end up with more repair bills and eventually tear the whole thing out.

But the pond surprised us. We try to get up and walk around a few times a day. The pond became a natural place to look. We noticed fish getting bigger, plants and insects adjusting to their new environment. After two years we realize we really like the pond. Really. Although we don’t spend hours staring at it, it’s a quick way to leave the world of words and computers and stand quietly for a minute watching the fish.

The dogs join us. They enthusiastically tear out the back door—go immediately to the pond and the fish either stop moving or dive under a plant. The dogs get bored and wander away. Then the fish come out again, gradually appearing for us to watch. Sometimes the dogs return for a drink or another look. They like to grab a bite of one of the water plants. If they return, the fish again freeze or dash away. As far as we know, the dogs have never tried to or actually caught a fish; there must be some instinctual process that goes on.

Today’s New York Times had an article by Amanda Schaffer about the scent of fear. She discusses recent research published in Current Biology. A neuroscientist in Singapore found that when zebra fish are injured, they release molecules into the water. Fish nearby become alarmed and do what fish do–either take off or freeze. Another new discovery that makes life interesting.

So, I like the thought that fish can smell fear. I think we can too.

Charles H. Elliott, Ph.D. <![CDATA[Uncontrollable Impulses: Hard to Treat; Hard Stop]]> 2012-05-26T03:16:22Z 2012-05-25T20:54:09Z Many people have problems that occur repetitively, disrupt their lives and seem completely out of control.  Sometimes we’re asked if these problems are examples of obsessive compulsive disorder (OCD). And indeed, there are some similarities to OCD. Nevertheless, these problems are not considered to be in the same category. So what are we talking about here?

Specifically, we’re referring to the category of emotional disorders known as Impulse Control Disorders. The similarity to OCD is seen in the fact that impulse control disorders, like OCD, are repetitive and very difficult for the person to bring under control. Furthermore, like OCD, they greatly disrupt and impair the sufferers’ lives.

However, Impulse Control Disorders also differ from OCD in important ways. Impulse Control Disorders, unlike OCD, often do not cause a great deal of distress to the person who has them—that is, unless or until legal authorities are called in.

Furthermore, distress, anxiety and upset do not play a very large role in most Impulse Control Disorders. In fact, many of those with Impulse Control Disorders actually report feeling pleasure from their behaviors even though their lives are impaired by them.

Some of the major types of Impulse Control Disorders include:

  • Pyromania: People with this problem find themselves irresistibly drawn to setting fires. They aren’t out to make money as arsonists are; rather, they set fires for the excitement of it. Unfortunately, for those afflicted with this problem, law enforcement agencies consider their behavior on a par with arsonists; in other words, they don’t cut them a lot of slack.
  • Kleptomania: These folks find themselves stealing repeatedly, yet they rarely need the things they steal. Rather, they feel tension prior to stealing and great pleasure and excitement when executing the theft. Later, they may feel remorse, but it such remorse fails to stop their behavior. As you can imagine, more than a few of these people eventually wind up in jail.
  • Pathological Gambling: Not just anyone qualifies as a pathological gambler and thus have an Impulse Control Disorder. Only those who gamble themselves into serious problems financially over and over again receive this label. These folks sometimes even steal or engage in other illegal behavior just to keep their habit going. They may “know” what they are doing is a problem, but report feeling unable to stop.
  • Intermittent Explosive Disorder: People with this problem report feeling unable to put the brakes on repeated episodes of aggression. They often harm property as well as people. When they feel the impulse to be aggressive, they say they “can’t help themselves.” Again, law enforcement agencies, not surprisingly, see their behavior differently.
  • Compulsive Buying: Though not officially recognized as an Impulse Control Disorder in the current version of professionals’ diagnostic manual, people with this problem look very much like those with other Impulsive Control Disorders. They can’t stop themselves from buying “stuff” that is frequently completely unnecessary. They do so to the extent that their finances end up in ruins. They feel great when they buy something, but that feeling is fleeting and often replaced by guilt and shame. In spite of those feelings, they continue the cycle repeatedly.
  • Trichotillomania: This is a common problem and involves repetitive, irresistible urges to pull out strands of hair. Sometimes Trichotillomania results in bald patches or even complete baldness. People with this problem often report feeling some pleasure from pulling hairs, whereas others say their main motivation is a reduction in anxiety or distress.

Treatment of Impulse Control Disorders has lagged behind the treatment of many other emotional disorders such as depression, anxiety, and obsessive compulsive disorder. There are some indications that treatments such as Habit Reversal Training may have value for Trichotillomania. However, most of the Impulse Control Disorders beg for more research on potential treatments.

Of course, even if we had a plethora of effective treatments, there’s still the problem that most of those with Impulse Control Disorders aren’t all that interested in getting help. Sigh.

Laura L. Smith, Ph.D. <![CDATA[Insurance “Help” Lines: Talk About Anxiety Attacks!]]> 2012-05-23T00:09:47Z 2012-05-22T19:32:23Z One of the best things about writing a blog is that you get an occasional opportunity to complain. Today I am going to complain about insurance company “help” lines. Help is definitely the wrong word. More like unhelpful lines, or anxiety attack lines.

First, it seems like many of these companies really don’t want you to call them. They make sure that the wait is long. Like, really long.

My favorite trick is calling multiple phone numbers, being put on hold for 15 minutes for each number, and then finally being told that I have not reached the right department. That’s in spite of the fact that I was using the phone numbers provided on the back of people’s insurance card or a number given to me by one of the multiple people who agreed to speak to me after 500 loops of “we value your call.”

Today’s call was particularly annoying. I was in a feedback loop that kept on telling me to speak the member’s ID number. Within that particular ID number was the letter “A.”

The voice recognition software did not seem to be capable of recognizing the letter A and kept on repeating back the identification number as if it had an “8” in it. This kept on going on and on. I tried to say “A” ever so clearly. I elongated the A sound. I paused between the numbers before and after. In desperation I said, “A like apple.” Finally the recorded voice said “Sorry you are having trouble,” and hung up! Even Siri can do better than that.

Okay, stay calm and redial. I tried again. I still could not get the software program to understand that A was A and not 8. So then I tried to hit # hoping to get a real person. That didn’t work. Then I hit the * button. No dice. Then I tried O for operator. The recorded voice was quickly getting ready to hang up on me. What to do? I gave up and walked around. I went outside and looked at the fish pond. I got a glass of water.

Then, after some deep breathing, I called another number. Several numbers later, I actually got to speak to a real person. And do you know what they said? The client was not covered for the services that I had already provided.

So, in the scheme of things, not getting paid for one person is not a big deal. But this seems to be happening with greater frequency. What is sad is that, if left untreated, mental health causes people to suffer, miss work and get physically sick. So what seems to be saving some insurance company a few dollars in the beginning will end up costing us all in the long run.

So, let’s see. I have to take a deep breath and ever so slowly exhale. Then another. And another…


Laura L. Smith, Ph.D. <![CDATA[Just Because You Feel Something, Doesn’t Make it So!]]> 2012-05-20T21:37:49Z 2012-05-18T19:06:06Z A couple of weeks ago, I wrote a blog about believing what you think. The point of the blog was that people have thoughts all of the time that aren’t really true. For example, people who fear public speaking might think that if they speak in front of a group of people their voices might shake and people will think they are fools.

Today, I want to discuss feelings. This subject is a bit more complex because you’ve probably been told that all feelings are okay. And that people feel what they feel. Sometimes, that’s true. But feelings can also get in the way of people’s happiness.

Let’s start with the feeling of anger. Anger is an emotion that helps people stay safe. Parents’ get angry when someone threatens their children. Anger increases attention to threats. However, when people get angry too often or over small things, anger can become quite destructive.

Indulge me for a moment in what may sound like a diversion. This morning, I was at the gym walking around the track. It’s just a little track about 1/16 of a mile and maybe three feet wide. Most people walk around the track between exercise sets or during a warm up or cool down. A few people jog.

So, this morning I’m walking around the track and I see a guy running. Three people are walking in front of him and obviously don’t notice that he’s behind them. Well, this guy looks angry. Really angry—he kind of yells at the three people on the track who are still not noticing him. Then, unbelievably, he kind of pushes through between two of the people with a look of utter loathing on his face.

The question is, does this guy have the right to be angry? Well, if feelings are always true, then of course he does. But, is his anger helpful to him? Does his anger protect him of his loved ones? No. Can he change his feelings? Yes, he can.

You might wonder how. He could do it by changing the thinking that led to his outburst. Thoughts that someone in his position could easily have include, “People have no right to get in my way,” “I’m running and they are walking, so they should clear out and get off the damn track!” or “Stupid people; they should pay better attention!” And you could easily argue that these thoughts could have an element of truth in them.

However, they’re a tad extreme and lead to anger or rage which can either provoke a fight or simply harm the health of the angry person if he feels this way often (and he probably does if he gets so upset over something so trivial). Alternative, more useful thoughts could include, “I wish people would pay more attention,” “Maybe I could be clearer in letting the people in front of me know I’m coming,” or “If I really want to go jogging without other people slowing me down, maybe I’d be better off doing it outside or somewhere else.”

So, just because you feel something, doesn’t make it true. More often than not, intense negative feelings of anxiety, sadness, anger, or rage are brought on by distortions in people’s thoughts. As a fortune cookie I recently saw said, “All personal breakthroughs begin with a change in beliefs.”

Seriously, I saw that from a fortune cookie!

Angry man photo available from Shutterstock.

Charles H. Elliott, Ph.D. <![CDATA[Obsessing About Your Body]]> 2012-05-17T03:12:00Z 2012-05-15T22:34:22Z Most people can find one thing or another that they don’t like about their bodies. For example, maybe you feel you have a few unwanted pounds, perhaps you don’t like the size or the shape of your nose, or maybe you struggle to deal with your complexion. If so, your concerns fall within a normal range.

There’s no reason to think you have a serious problem. In fact, if you saw your face and body as totally, wonderfully, gorgeous and without flaws, many people would think you were narcissistic.

But there’s a problem called Body Dysmorphic Disorder (BDD) that takes normal, minor dissatisfactions to a level that lies far outside the range of normal. People with BDD have heart-rending distortions of their own bodies. They obsess and feel anguish about one or more perceived bodily flaws.

More often than not, they view these imperfections as grotesque. Some typical concerns of those with BDD include worries about having:

  • A forehead that seems too small or too large
  • A slightly crooked nose
  • A chin that feels too large or too small
  • A penis that’s seemingly too short or too narrow
  • Slight discolorations of the skin
  • Ears that don’t look quite right to the person
  • Crow’s feet

Those with BDD often shift their concerns from one imagined defect to another over time. You might review the list of supposed defects above as trivial concerns. But people with BDD seriously believe that their bodies are painfully deformed, blemished, or disfigured. But a hallmark of the disorder is that other people rarely see them that way; in fact, other people often do not even perceive anything at all as wrong with the actual appearance of those with BDD.

Yet when people with BDD worry about these issues, they sometimes engage in a host of rituals or compulsive behaviors in order to feel better. Unfortunately, they feel better only for a brief time.

Some of the compulsions include seeking plastic surgery (often many times), asking others for reassurance about their appearance, checking their “defects” in the mirror over and over again, seeing dermatologists excessively and requesting numerous procedures, wearing gobs of makeup to hide their presumed defects, picking at imagined skin imperfections and thereby causing irritations and scars, wearing clothing designed to hide their presumed deformity, extensive body building, steroid injections, supplements, and hormones to build body mass, and on and on.

If you think that BDD sounds a lot like obsessive compulsive disorder, you’re right. BDD has a lot in common with OCD. However, there are a few differences. For example, unlike OCD, those with BDD are more often depressed; they often have less insight into their problem than people with OCD, and some of the compulsions associated with BDD don’t occur as often as the compulsions of people who have OCD.

For example, you don’t exactly have plastic surgery a hundred times a day in the way that someone with contamination OCD might wash their hands that often. But trust me, some people with BDD do seek and obtain an astonishingly large number of plastic surgeries over time—and each time they think “this” surgery will finally be the one that corrects the problem, but it never seems to work out as planned. So they have another plastic surgery and then another.

So BDD does look a lot like OCD. And in actuality, whether or not BDD should truly be called a disorder that’s different from OCD or simply a subtype of OCD is an open question. We can think of arguments for both sides of that issue.

The bottom line is that if you or someone you know has BDD, get help. BDD is a serious problem that disrupts lives, ruins relationships, and sometimes leads to depression and even suicide.

Man with broken nose photo available from Shutterstock.

Laura L. Smith, Ph.D. <![CDATA[Through the Looking Glass: Social Anxiety and Self-Absorption]]> 2013-12-10T13:38:29Z 2012-05-10T16:32:16Z Mirror mirror on the wall, why is everyone always looking at me? Some people believe that others are always looking at them and judging them quite harshly. It’s like there are mirrors everywhere and they all reflect imperfections.

People have social anxiety when this feeling becomes overwhelming and interferes with daily life. Symptoms of social anxiety include fears of:

  • public speaking
  • going to parties
  • meeting new people
  • speaking up to authority figures
  • eating in public

Anxiety in those with social phobia usually includes physical symptoms such as sweating, rapid heart rate, upset stomach, flushed face, and shakiness. The prominent emotions are fear and dread. The difference between shyness and social phobia is one of degree—those with social anxiety have a very, very bad case of shyness that leads to severe limitations in life.

People with social phobia believe that they will certainly be humiliated, embarrassed, or shown to be inadequate. It’s no wonder that those with social anxiety tend to withdraw from others. And the more they withdraw, the more anxiety wins.

Social phobia can be successfully treated with cognitive behavioral therapy (CBT). Elsewhere in this blog we have written about exposure which is the “B” in CBT. Exposure involves coming face to face with fear, usually done in a planned, systematic way. The cognitive part of treatment involves looking at the way thoughts influence feelings, helping clients identify unhelpful thoughts, and replacing them with more adaptive thoughts.

Self-absorption is a common theme of the thoughts of those with social anxiety. Self-absorption involves paying excessive attention to oneself. It’s like a camera is constantly turned on to you and the picture it transmits is too bright and quite unflattering. Common thoughts related to this theme include:

  •         Everyone is looking at me
  •         I might go crazy
  •         I’m not capable of handling this
  •         I must look foolish
  •         I can’t stand to be in public
  •         I know I’ll sound stupid

So how does one address the self-absorption underlying such socially anxious thinking? Realize that the rest of the world does not focus on you nearly as much as you think. Typically people walk around more focused on their own concerns than on judging you or others.

Start noticing how often you see other people doing exactly what you worry so much about. For example, listen to two people talking at a gathering. Inevitably, you’ll hear a few unintelligible phrases, social gaffes, boring, or grammatically incorrect statements. So what? Do you evaluate others as harshly as you do yourself? Probably not.

If your social anxiety interferes with your life, makes you miserable, or keeps you from doing what you want to do, there are treatments that work. Please seek help and be kind to yourself.

Woman in the mirror photo available from Shutterstock.

Charles H. Elliott, Ph.D. <![CDATA[Are Anxiety and OCD the Same Thing?]]> 2012-05-10T04:15:33Z 2012-05-08T16:30:00Z Obsessive Compulsive Disorder (OCD) involves feelings, thoughts and behaviors. For the vast majority of people with OCD, the feeling of anxiety stands out as prominent.

For example, a man with OCD might have an obsessive thought that a doorknob is contaminated and the thought of touching the doorknob causes him great anxiety. He takes a spray bottle of disinfectant and sprays the doorknob, which decreases his decreases. Then he reaches for a Kleenex to give him a barrier from any possible remaining germs. He feels relieved. And that momentary relief feels pretty good; well, that is until the next doorknob appears.

The pattern repeats: an obsessive thought, an overestimation of danger or risk, increased anxiety, a compulsive action, and then feelings of relief provided by the compulsive action.

OCD also involves thoughts.  For some people with OCD, their obsessions and compulsions are more in their heads than in their guts. Consider a woman feels compelled to count everything she sees—ceiling tiles, stairs, books on a shelf, you name it; she counts it. But she actually reports feeling not particularly anxious at all. It’s just that she feels things aren’t “right” if she doesn’t count everything imaginable. Her feelings are more about distress over things being out of order rather than anxiety.

OCD can also show up primarily in behaviors. For example, a man might feel a driven need to go through doorways in a particular manner. Until he gets it “right,” he can’t let himself continue on his way. He can’t come up with any particular thoughts about why he needs to go through doors in this way; he just feels he must. And that feeling of having things be “just so” isn’t exactly the same thing as anxiety.

As these examples illustrate, OCD manifests itself in many widely differing forms. The prominent feature(s) may involve anxiety, thoughts, behaviors, urges, or distress. Although OCD is currently considered a type of Anxiety Disorder, many professionals believe it deserves its own separate diagnostic category. In part, that’s because much of the urges and distress brought on by OCD just don’t look like classical anxiety.

The take home message is that this is a fascinating, yet quite complex disorder. If you “think” you may have OCD, consider seeking professional consultation. This is one problem that you don’t want to self diagnose. The good news is that treatments for OCD work very well.

Anxious man photo available from Shutterstock.

Laura L. Smith, Ph.D. <![CDATA[The ABC’S of Behavior]]> 2012-05-01T20:14:32Z 2012-05-01T18:57:38Z Most days I think about how dog training has influenced my therapeutic style. If you are a client, you have probably heard some of my favorite dog stories.

I often talk about how I forgot my training and turned my dog Sadie into a frightened mess of fur whenever a thunderstorm rolled through. It was pretty cute when she was a puppy and would cuddle up next to me for protection. I’d pet her and say whatever silly dog stuff you say to your dog when she’s scared. Now, she weighs well over 60 pounds and when she gets too close between her fur, dog breath, and weight—it’s not quite as cute.

Let’s take a look at what I did wrong with Sadie and see what lessons I can learn.

First, there was the antecedent (the original thing that happened), in this case thunder. Then the behavior (Sadie gets close to me and wants comfort). Then the consequence, I pet Sadie and whisper soothing words to her.

Okay—here it is in behavioral terms:

  • A (antecedent): Thunder
  • B (behavior): Seeks comfort
  • C (consequence): Gets comfort

All well and good. Now Sadie feels better, so what does she think, okay not really “think,” but, what does she learn? She learns that if she wants to be petted, she acts scared. So, now she starts to get scared of not only thunder but fireworks, trucks rumbling by, jets—you get the idea. Pretty soon the A part of behavior grows because the C part of behavior feels good.

So, if you have a child that is afraid of something, make sure that you don’t make the fears grow by mistake. Instead, give your children the confidence and power over things that make them nervous. For example, let’s say your child is worried about traveling on an airplane. So A, in this case, is getting on an airplane. Your child stays close to you and wants your guarantee that nothing bad will happen. You don’t want to lie and say that airplanes never crash.

But you might be tempted to give lots of comfort and reassurance. If you read the earlier part of this blog, you see that could be a problem. You could actually make things worse.

So what’s a good, caring parent to do? Well, you can talk briefly about how safe airplane travel is and that millions of people fly every day without problems. And you probably want to tell your child that planes often experience a little turbulence which is not a problem and doesn’t mean the plane is going to crash.

In other words, you give kids simple, brief, clear, realistic expectations and you avoid excessive reassurance. More later, we’ll keep talking about ABC’s.

Charles H. Elliott, Ph.D. <![CDATA[Health Anxiety]]> 2012-04-24T17:23:13Z 2012-04-23T19:15:09Z About ten days ago, Laura and I came down with the plague. Well, OK, not the plague. More like the flu actually. We experienced energy draining fatigue, headaches, fever, chills, a constant cough and even back pain. We spent close to two days in bed and have just now overcome our symptoms with the sole exception of a lingering, but dissipating cough.

Of course we wondered if we could have done something to prevent this malady from occurring. When we saw our doctor, he suggested that we might have gotten our flu shots too early this year (apparently, they reformulate the shots as the year goes on). Of course, he said we had no way of knowing that and, no, he wasn’t recommending that we start getting two flu shots a year.

Maybe we didn’t wash our hands often enough. Or maybe we weren’t sufficiently attentive to getting enough sleep every night. Or maybe we spent too much time around crowds at the mall. Maybe…YIKES! Stop it!

We could see ourselves starting to fall into classic health anxiety so we rethought our concerns a bit. In doing so, we realized that we usually engage in most of the truly important behaviors for reducing health risks—we don’t smoke, we keep our weight under control, we have a good diet, we exercise and so on.

Worrying about people’s sneezes, washing hands excessively, avoiding crowds, etc, do little to nothing to actually prevent most cases of the flu. But they can cause stress and take up a lot of time if you let such worries spin out of control.

How about you? Do you let health worries dominate your life or is your health anxiety a normal, subclinical concern? Here’s a list of some questions to ask yourself in order to answer that question:

  • Do you spend an hour or more most days worrying about your health?
  • Do you frequently ask other people to reassure you about your health status?
  • Do you take precautions against contact with germs that most people don’t (e.g., using Kleenex to open doorknobs)?
  • Do your worries interfere with living a happy life?


If you discover that health anxiety interferes with your life, get help. You can overcome this problem by working on it. A good therapist can help you to see that most “over the top” strategies to keep you well (e.g., using hand sanitizer ten times a day), rarely accomplish their goal.

You can learn to stick to the basics for keeping yourself healthy. And you can learn that if you do get sick, you’re quite likely to cope with it just fine. People get sick all of the time and they generally get better and move on with their lives. You can do the same with a little help.

Sick woman photo available from Shutterstock.

Laura L. Smith, Ph.D. <![CDATA[In Sickness and In Health]]> 2012-04-21T04:31:59Z 2012-04-20T20:44:27Z Like zillions of people around me who have shared a similar fate, a spring virus, unexpected and unplanned for, has fouled up my week. I spent a couple of days dazed—sleeping on and off—then a slow recovery. No single second was terrible, I’ve had much worse, just aches and pains, chills, and a deep cough. But the fatigue, the slogging through molasses deep tiredness of this bug, has gotten my attention.

Now I’m in the state of wellness that gives my brain permission to mull over all of the tasks that illness made seem impossible. And still tired enough that the simple tasks take on monstrous proportions. Two blogs to write, bills to pay, balances to figure. And of course, shopping and cooking. Cleaning, catching up on email, scheduling appointments. Too much for today. But, now on top of these lists, I pile stress and anxiety.

Here I go; catastrophizing. But years of helping others (including myself) deal with stress have given me some tools; coping strategies to pull out when thoughts start to overwhelm me. So, if you, like me, have had a spring bug interfere with your life, here are a few tips:

  • Breathe…always a good idea, but during times of stress breathing becomes even more important! Take a few deep breaths and let out the air slowly (well, that started an unbelievable coughing fit so maybe I’ll skip this step).
  • Write a list….of all of the things you need to do. Writing things down make it easier for you to remember without the stress of having to keep all of those details in your head (oh no, 438 things to do—what a bummer).
  • Keep things in perspective…okay, in a couple of days I’ll feel better and the list will slowly decrease and the stress will reduce in kind. I’m grateful that I can get out of bed and make a list. How’s that for positive thinking?
  • Get enough exercise…I love to exercise. Wait that’s probably where I picked up this bug—at the gym. My doctor told me that my exercise for the week is to take a nap. Good idea.

Sick young man photo available from Shutterstock.