Problems Treated

Research suggests that perhaps more than half of Americans will experience a psychological disorder in their lifetime.  These can include, for instance, various types of depression, anxiety, family problems, or substance abuse.  Often, psychological disorders do not go away completely.  They seem to represent the less resilient aspects of ourselves that to some extent stay with us.  They may fluctuate between mild to severe, or go away and then re-occur.  Also, each disorder rarely occurs alone, but rather co-occurs with one or more other psychological disorders during a lifetime.  But many mental health researchers feel that the idea of a “disorder” may be too simplistic.  Disorders are not necessarily distinct from one another.  Also, most disorders include elements that we all experience from time to time. On the other hand, for someone with an anxiety disorder, the worries, anxiety, avoidance, and checking can be extremely distressing and lead to depression, impairment of normal social, familial, school or work activities, and substance abuse.  What follows are brief descriptions of the psychological disorders treated at the Anxiety Center of Marin.

PANIC DISORDER:  Panic Disorder essentially means fear of panic attacks.  Many people (perhaps one out of five) experience panic attacks, yet most are not frightened about them.  They are very uncomfortable, but are usually understood not to be dangerous.  Most people float with them while the adrenalin burns off and within a half an hour or so, feel recovered and may feel a little “off” for an hour or so afterwards (like they just ran an Olympic sprint).  A panic attack is a sudden and severe onset of anxiety which may include, for example, heart racing, difficulty breathing, feelings of dread and needing to escape, light-headedness or dizziness. Strong symptoms of anxiety should be reviewed with a physician to help rule out other medical problems and help make the diagnosis of panic attacks.  But some individuals go on to experience Panic Disorder. They are afraid that one or more consequences might occur if they have a panic attack:  1) physical harm; 2) social humiliation; 3) loss of mental control.

AGORAPHOBIA:  In most instances, Agoraphobia refers to the experience of great emotional distress in, or avoidance of situations where one fears having a panic attack.  In other words, it often accompanies Panic Disorder.  Situations include shopping malls, church services, parties, restaurants, airplanes, bridges, freeways, doctors offices and even medical and dental procedures such as MRIs where the patient feels trapped and afraid of having a panic attack or in some cases a more limited symptom (not quite panic).  Again, the underlying fear here would be either physical harm; social humiliation; or losing mental control and somehow not being able to get help.

SOCIAL PHOBIA:  This very common disorder often occurs in people who do not appear shy or nervous to others.  Many are successful professionals, have graduate degrees, are married and have children.  These patients often hide their fears or avoid situations such as work promotions or speaking up in class or using public bathrooms.  Others may not notice.  On the other hand, many people with Social Phobia have difficulty even walking outside or registering for a class or applying for any job.  Performance anxiety (e.g. public speaking) is a specific phobia of social anxiety but does not account for most cases.  Usually, Social Phobia, also referred to as Social Anxiety Disorder, is “Generalized.”  Essentially, Social Phobia involves an exaggerated fear of negative evaluation, severe social embarrassment or humiliation.  It can also involve a more physical self-conscious feeling about being observed by others (like in a fishbowl).  Small talk, presentations, speaking up in class, asking someone out for a date, public speaking, job interviews, accepting promotions, using public or friend’s restrooms, signing checks in public, eating out at restaurants, intimate conversation, talking on the telephone, and flying in an airplane, are all examples where avoidance or serious emotional distress often occur.

OBSESSIVE COMPULSIVE DISORDER:  Obsessive Compulsive Disorder or OCD may take a variety of forms.  Six of these seem to account for most of OCD.  Many sufferers experience more than one form and symptoms may change over time. 

  • Checking.  These sufferers feel compelled to check door locks, stoves, electric appliances and outlets, etc. for fear of harm to self or others if a device is left on or unlocked for instance.  Another example would be fear when going over a bump in the road that a person was run over, even though common sense tells the OCD sufferer that no people were present or the bump was too small to be a person.  Another example would be fear of not reading something correctly.  Repetitive reading results.  This can interfere with paperwork, email, school coursework , reading a magazine or novel, and one’s performance at work.  Situations and devices are checked over and over with a sense that maybe “I didn’t see it correctly, or forgot to check it.”  Memory and perception are not trusted. 
  • Washing.  These individuals feel compelled to wash their body, kitchen counters, car seats, clothing, etc. for fear of exposure to chemicals or germs or dirt.  We all wash, but like the “checker,” the “washer” doesn’t trust when enough is enough.  They wash repeatedly and unnecessarily.
  • Intrusive Thoughts.  People often have unwanted thoughts which seem to intrude into everyday thinking.  They may by quite violent; they might also involve unwanted sexual ideas; other painful intrusive thoughts may occur as well.  Almost everyone has such thoughts occasionally; however, for the OCD sufferer, these thoughts are considered important even though the sufferer knows rationally that he or she would not actually behave in this way.  The person is quite disturbed by them. Again, they are unwanted and they intrude.
  • Magical Thinking.  These individuals have personal, made up superstitiouns.  They feel that some ritual must be practiced or some thought or behavior avoided or something horrible will happen such as a death or injury of someone they know. The sufferer must walk, touch things or count things in a certain way for instance. Sometimes the feared consequence is vague and hard to pinpoint.
  • Symmetry and Perfectionism.  Items must be straight, lined up in a certain way, or placed just so.  Handwriting must be perfect.  Something out of place creates an intolerable feeling of anxiety.
  • Hoarding.  These individuals sometimes purchase or collect things excessively or have trouble disposing of even normal items such as old clothes, food, papers, etc.  They often accumulate piles of papers and other objects which have not been put away.  Making small decisions about throwing something away, putting something away, or giving something away (donating) are extremely difficult.  As a result, things pile up.  Often household tables, counters, hallways, floor areas become unusable because of severe clutter.

GENERALIZED ANXIETY  DISORDER.  These patients have frequent episodes of worry, often many times a day.  They worry excessively about such things as paying bills, traffic accidents, illness, etc.  Their anxiety goes up and down as the individual is confronted situationally or mentally with a worried thought. 

SPECIFIC PHOBIAS.  These include for instance, fear of heights, flying, driving, public speaking, closed spaces, or animals.  These individuals usually know their fears are exaggerated but like all anxiety disorders they continue to wonder “what if.”  Thus, they either avoid situations or endure them with much distress.

MEDICAL and DENTAL PHOBIAS.  These phobias are sometimes over-looked by medical professionals. The patient may be “non-compliant,” fail to schedule procedures, or cancels appointments. Often “motivation” is not the issue; rather, it is fear. Medical phobias can include simple doctor or dentist visits; diagnostic procedures such as blood tests, EKGs, MRIs or CT Scans;  treatment procedures such as needle injections, general anesthesia, physical therapy, surgery, and post-surgical pain and recovery. Often fear of panic, being trapped, fainting, or social embarrassment may underlie a Medical Phobia.  As medical professionals know, failure to follow through with medical diagnosis and treatment can carry serious risks.  These risks can include worsening illness, injury, or death.

DEPRESSION.  Unlike an anxiety disorder, clinical depression often affects mood in many situations which are not stressful in and of themselves.  Getting easily frustrated over small things is a common symptom of Clinical Depression.  Depressed mood, tearfulness, loss of interest in normally pleasurable activities, lowered feelings of self worth and suicidal feelings are common symptoms.  Getting increasingly frustrated or irritable, having constant ruminative worry, difficulty concentrating or remembering things, problems sleeping or with appetite can all feel like symptoms of anxiety.  But they are also common symptoms of clinical depression.

SITUATIONAL STRESS.  Marital problems, grief over loss of a friend, work conflicts, or financial uncertainty are all examples of situational stress.  These stressors may be temporary, but can also be quite distressing and impairing and can lead to more serious problems over time such as an anxiety disorder or clinical depression.