Anxiety disorders and obsessive compulsive disorder

- [Lecturer] While we have all felt anxiety at one point or another, for a few of us it might go a little bit further than that. For some members of the population, their anxiety would actually meet the definition of what we call anxiety disorders. Anxiety disorders are characterized by distressing, persistent anxiety and we're going to focus on five of them. The first one we're going to talk about is generalized anxiety disorder which I'm going to abbreviate here as GAD. And this disorder is used to describe a person whose general state is one that is continually tense and uneasy. So the person is incredibly tense. They're apprehensive, they worry constantly. Enough so that it actually starts to influence their lives in the sense that they're sleep deprived or maybe they don't eat well. And to be classified as generalized anxiety disorder, this anxiety must last six months or more. So let's go over a few more interesting things about this disorder. One of them is that it actually has identifiable physical symptoms. In particular, things like a furrowed brow or twitching eyelids or trembling or just general fidgeting. Another interesting thing about this disorder is the population that it affects, specifically it mostly seems to be present in women. In fact, 2/3 of the population that has this disorder are female. Another thing about generalized anxiety disorder is that the source of the anxiety is not always clear. So there's an unclear source. Meaning that in general, people with generalized anxiety disorders often can't identify and therefore deal with or avoid the cause of their stress and therefore the cause of the disorder. And eventually if this continues over a long period of time, this constant worry can actually wreak havoc on someone's body. And it can eventually lead to things like high blood pressure and other more serious symptoms. And another thing that I'll point out because this might come up later is that sometimes disorders can be present at the same time as other disorders, and in the case of generalized anxiety disorders, it seems that people with this disorder seem to also have a diagnosis of depression. So let me sort of draw a dotted line here and I'll write depression right underneath it. So depression isn't part of generalized anxiety disorder, but sometimes seems to go along with it. The next type of anxiety disorder that I'm going to talk about are panic disorders. While generalized anxiety disorder is a continuous, fairly high level of anxiety, panic disorders are a sudden burst of sheer panic and intense fear and usually we refer to these episodes as panic attacks. And these attacks can last for minutes or sometimes longer, although apparently they feel like they're a lot longer and they can be associated with a number of different physical symptoms. Things like heart palpitations and sweating and chest pain and shortness of breath. Some people report feeling that the walls around them are closing in on them, and perhaps not surprisingly people who have panic attacks sometimes think that they might be suffering from a heart attack. So let's write some of these things down. So panic attacks are sudden, they're intense, and just like with generalized anxiety disorders, panic disorders aren't simply some kind of solely psychological phenomenon. There are physical symptoms as well. And one thing to keep in mind for panic disorders is that these panic attacks are usually in response to situations that don't necessarily warrant that kind of stress, and by that I mean that there might be situations where that level of panicking might be appropriate perhaps if someone were to break into your house, or if you were being attacked by someone, but this type of panic goes above and beyond those symptoms and it is also in response to different triggers that might have meaning only to the person who is suffering from panic attacks. Let's move on to phobias. And phobias are cases where a person is irrationally afraid of specific objects or specific situations. And so unlike the other two disorders that we've talked about so far, this is focused anxiety. And depending on what that anxiety is focused on, people can either live fairly normal lives, so someone who has a fear of snakes probably doesn't actually come across snakes that often, but it can also be extremely debilitating. So imagine the life of someone who has a phobia about leaving their own home. Another interesting thing about phobias is that they tend to follow a pattern. And by that I mean that people seem to have phobias about specific sub-types of things. That doesn't mean that someone can't have a phobia about something incredibly random, maybe a thumbtack, but in general phobias are typically associated with fear of animals, also insects, things like blood, or enclosed spaces. Fear of heights is also a common one. And as I said these aren't the only phobias, but these are some fairly common ones and as you can probably imagine people with these kinds of phobias typically get by by avoiding these objects or by avoiding situations where they can possibly come into contact with the focus of their phobia. However there are some other kinds of phobias that are not so easy to avoid. For example, social phobias. And as you have probably figured out, social phobias include fear of different social situations so they could for example manifest in an incredibly intense shyness, or maybe an intense fear of being scrutinized by others. And so individuals with social phobias will try to avoid situations where they have to talk to people or where they feel like they might be judged, or they might try to avoid any situation that they feel might lead to embarrassment. Let's move on to our next anxiety disorder, which is obsessive compulsive disorder which I'm going to write here as OCD. And this is a disorder that is characterized by unwanted, repetitive thoughts which are referred to as obsessions. And also unwanted repetitive actions which are referred to as compulsions. And I think we probably all have a few behaviors in our lives that might fall under one of these headings. For example, I know that I like to double check to make sure that my door is locked or that my oven is off. And if I don't do these things, I actually feel pretty uneasy. However, once I check, once I look to make sure that my oven is off or once I touch the doorknob to ensure that the door is locked, then the worry is gone. It doesn't continue to occupy space in my mind, and I no longer think about it. And that's where my behavior and my thought patterns differ from those who have obsessive compulsive disorder. Because for these individuals, their obsessions and their compulsions persistently interfere with their everyday life and wind up causing serious distress. So touching something gross and then spending a minute washing your hands, that's fine, but continuously washing your hands multiple times throughout the day, so much so that your skin becomes raw, that behavior is a problem. And there are a couple of common obsessions that people typically seem to focus on. One is a concern with dirt or toxins, so concern that things are dirty. Another is an intense fear that something terrible is about to happen. I'm gonna write that down as bad future. So maybe they're constantly worried about someone in their family being sick or having an accident and while I think we all worry about that at one point or another, for people with obsessive compulsive disorder, these thoughts sort of invade their head and I think about them so much that it prevents them from thinking about other things. Another common obsession is a need for symmetry. And this might be a stereotype of obsessive compulsive disorder that you've heard about before. But this describes cases where people feel uncomfortable unless the things around them are ordered. And I think that this makes a little bit of sense if you think about it. I know that when I see one book that's leaning on a different angle on my bookshelf than all the other ones, it sort of bothers me. I sort of feel like I have to fix it, but I also don't think that anything bad is going to happen if I don't fix it. And it's not going to stay with me. Once I walk out of the room, I'm probably no longer thinking about that book or that bookcase. For those who have this type of obsession though, thoughts and worries about symmetry and order will continue to bother them throughout the day to the point where they won't be able to think about or focus on other details of their lives. There are also a number of common compulsions and I'll write these underneath. One of them has to do with washing. And this one include an intense need that people might have to wash their hands or to bathe or to groom in some way. Another compulsion is one that I sort of mentioned before which is feeling the constant need to check doors or locks or appliances, but unlike just checking them once and then thinking it's fine and walking away, people who have this type of compulsion might have to repeatedly check to make sure that everything is turned off or locked, and you can imagine how this might affect someone. Let's say that you really need to get to class, so you get your backpack, you run out the door, and then you wonder whether or not you locked that door and so you go back and check, and then you check again. And this behavior continues, so much so that it interferes with your daily life. I'm gonna summarize this as just putting down checking. And another type of common compulsion is what I'm going to refer to as a movement ritual. And this would include things like feeling the need to repeatedly stand up and sit down on a chair or enter and leave a room, or maybe feeling a continuous need to tap on a desk. And this disorder is actually not all that uncommon. Some research I found suspects that two to 3% of people will meet the criteria for obsessive compulsive disorder at least once in their life. Interestingly, this mostly includes teens and young adults. The last anxiety disorder that I'm going to talk about is post-traumatic stress disorder, which I'm going to write here as PTSD. And this describes the situation when a person has lingering memories and nightmares about a past event, so much so that it negatively impacts their daily life. So it's characterized by haunting memories. And repeated nightmares. And also includes other physical symptoms like insomnia and unlike the other disorders that we have talked about so far, PTSD typically has some kind of a trigger, or something that leads the disorder. So soldiers coming home from war where they've seen atrocities or survivors of terrible accidents, or someone who has witnessed a disaster like 9/11. Things like violent and sexual assaults. All of these things can lead to this disorder, and while any of those situations might initially cause these symptoms, it's described as PTSD when these symptoms persist for over four weeks. Meaning that it's probably not that surprising if you have nightmares immediately after witnessing something terrifying. However, for most people those nightmares would eventually stop or become incredibly infrequent. For individuals with PTSD, these symptoms can continue well after the event was passed.