We all worry.  Sometimes we have something legitimate to worry about: waiting for results from the doctor, going on a job interview,  or even simply being late for an appointment.  Anxiety disorders are different from worries because our normal calming strategies like distraction or getting information or talking to someone don’t work. Sometimes it seems like we worry A LOT ALL OF THE TIME.  This may be Generalized Anxiety Disorder (GAD).Sometimes we freak out and think something terrible is happening and go the emergency room.  This may be a panic attack or panic disorder. Sometimes we feel anxious about something “silly,” like checking the stove over and over and over to make sure it is off.  This may be OCD.  There are lots of forms of anxiety disorders and the bottom line is that the anxiety is so intense that it is impossible to live normally and nothing really seems to help.

Research has shown that the most helpful thing to do for anxiety in therapy to teach you new skills for coping with anxiety.  The particular kind of therapy that is most helpful is Cognitive Behavioral Therapy (CBT).  It takes specialized training to learn how to do CBT.  It also helps to involve family members in the therapy if possible.  Medication also sometimes can help but it is not generally as effective and you may be stuck taking a pill forever instead of learning how to retrain your brain’s responses.  First choice, psychotherapy and lifestyle changes. Second choice,  add in medication if the first two aren’t enough.

The most common forms are cleaning/washing to remove contamination (from germs or bad thoughts or fat/old/ugly/odd people or whatever) and checking (to make sure over and over that the door is locked, that no one was run over by a car, etc.)  Children, especially, but adults sometimes too, need for things to be “just right” or “just so” (asking a parent to say “goodnight” over and over until it feels right).  Sometimes people need to count –like the number of holes in an acoustical ceiling tile.

In addition to OCD with clear behavioral rituals, some people have primarily obsessional OCD –they may focus on religion and develop scrupulosity or have forbidden and unwanted sexual or violent thoughts, etc.  It may look like it is only about thoughts, but most people will invent a mental ritual to undo the bad thought like saying prayers or repeating mantras.

Freud thought that OCD was caused by over zealous toilet training.  This is completely false.  Parenting is not to blame.  The current thinking is that in most cases people inherit a biological predisposition and something triggers it into OCD.

Sometimes even infants show signs of OCD (wanting their diaper to be done “just right”).When little children have OCD they usually don’t realize that their brain works a little differently.  Boys with tic disorder are more likely to develop OCD.  Girls may develop OCD as they go through puberty and that the symptoms vary with her cycle.  Less commonly, a child can suddenly develop OCD from an infection like strep and the body’s own immune system attacks the basal ganglia in the brain.  If treated with antibiotics immediately, this kind of  PANDAS or PANS OCD can be treated and go away. Most rarely, OCD can be caused by a head injury or by trauma.

Usually, OCD responds best to professional counseling.  There are some self help books that will be listed later.  Plain supportive old talk therapy or relaxation training or psychoanalysis have been shown to be ineffective. The most effective treatment for OCD is Cognitive Behavioral Therapy (CBT) and a form of CBT called Exposure and Response Prevention (ERP).