Obsessive Compulsive Disorder (OCD)

OCD is characterized by repetitive, intrusive, and unwanted concerns (obsessions) that can come in the form of thoughts, images, urges or not-just-right feelings. Obsessions cause significant distress and disruptions in daily functioning. In response to the obsessions, the individual feels the need to engage in repetitive behaviors (compulsions) that serve to neutralize and temporarily alleviate the distress associated with their obsessions. This response inadvertently reinforces the intensity of and belief in the obsessions. OCD comes in many different forms.

Common obsessions include:

• contamination (e.g., dirt/germs, illnesses)
• harm to self or loved ones
• symmetry, order and exactness
• unwanted religious or sexual thoughts
• not-just-right feeling

Common compulsions include:

• hand washing or excessive cleaning
• excessive checking
• counting
• arranging or ordering
• ritualized prayer
• mentally reviewing situations
• repeating (e.g., erasing, re-reading)

Panic Disorder

Panic Disorder is often described as a “fear of fear.” It involves recurrent and at least partially uncued panic attacks accompanied by a persistent concern over having another attack and the consequences of such an attack. A panic attack is defined as the emergence of four or more physiological sensations (e.g., heart palpitations, dizziness, light-headedness, shortness of breath) coming to a surge within 10 minutes. These sensations occur amidst terror and severe fearfulness.

Agoraphobia

Agoraphobia is the avoidance of places or situations from which escape might be difficult or embarrassing, or in which help may not be available in the event of having a panic attack or panic-like symptoms. The “fear of fear” experienced with Panic Disorder often leads to Agoraphobia where the individual avoids situations due to the fear of triggering a panic attack. Common situations that are avoided as a result of these concerns include highways, travel, crowds, and physical exercise.

Health Anxiety

Health anxiety is characterized by an excessive fear of illness and/or death. These individuals often engage in excessive health-related “safety behaviors,” such as scanning their body for “symptoms,” seeking repeated reassurance from loved ones and medical professionals, and Internet research. These efforts rarely lead to more than temporary relief. Individuals suffering from health anxiety may also avoid health information and health professionals in an effort to prevent thinking about illness and the feared outcome of a medical diagnosis. Individuals with health anxiety also may feel more susceptible to disease and experience intolerance of uncertainty regarding physical symptoms, illness and associated feared consequences.

Specific Phobias

Phobias involve excessive and persistent fear of specific objects or situations, which is recognized as exceeding any actual danger. The fear causes significant distress and/or disruption in functioning. Common types include:

• Animal Type (e.g., dogs, cats, spiders, insects, rats, birds, and snakes)
• Natural Environment Type (e.g., heights, storms, and water)
• Blood-Injection-Injury Type (e.g., seeing blood, receiving a blood test or injection, watching medical procedures)
• Situational Type (e.g., driving, flying, elevators, and enclosed places)
• Other Type (e.g., choking or vomiting, loud noises, or fears of costumed characters)

Generalized Anxiety Disorder (GAD)

GAD involves persistent and excessive worry across a variety of routine domains. While the content of the worries is normative, the worries are difficult for the individual to control, have been present for at least six months and cause interference in functioning. The individual also experiences significant distress and physiological sensations (e.g., stomach distress, muscle tension, fatigue, sleep difficulties, irritability) in response to excessive worries.

Post-traumatic Stress Disorder (PTSD)

PTSD is an anxiety disorder that can develop following a traumatic event. The traumatic event is experienced with a sense of intense fear, horror, or helplessness. In children, the reaction often involves disorganized or agitated behavior.

Symptoms of PTSD include:

• Re-experiencing the trauma (i.e., flashbacks, nightmares, intense recollections)
• Hyperarousal (i.e., feeling jumpy or easily startled, difficulty sleeping and restlessness, irritability, difficulty concentrating, and hypervigilance or feeling on guard)
• Avoidance (i.e., avoiding places, people, events, or objects that remind a person of his or her trauma, emotional numbness, loss of interest in previously-enjoyed activities, difficulty remembering important aspects of the trauma, feeling cut-off from people)
• While many people can experience a few of the symptoms described above following a trauma, the development of PTSD occurs when a combination of these symptoms lasts more than one month and causes significant life interference. For some individuals, symptoms may develop months or years following the trauma.

Separation Anxiety Disorder

While separation anxiety is common among children between 18 months to 3 years old, it can become a disorder when it is persistent and causes impairment in the child’s development and functioning as they grow older. The disorder involves a severe fear of separation from loved one(s) often due to worries about something bad happening to self or the loved one(s) while they are apart. There also may be a fear of something preventing their reunion, extreme homesickness, and a fear of illness while away from the love one. Other symptoms include refusing to go to school, camp, or a sleepover, and demanding that someone stay with them at bedtime. Some children will exhibit oppositional behaviors (e.g., tantrums, aggression) in an effort to avoid separation.

Social Phobia

Social Phobia (or Social Anxiety Disorder) is characterized by excessive anxiety about being judged or rejected by others, or a fear of behaving in a way that might cause embarrassment. Social phobia may be specific to certain types of social or performance situations (e.g., public speaking) or more general, often leading to avoidance behavior and impaired functioning. Physical sensations that accompany anxiety (e.g., shaking, stomach distress, concentration challenges) can increase fear and embarrassment in social situations. Most adults and children with social anxiety find it difficult to initiate conversations, share opinions, speak in groups, make eye contact, and pursue friendships and romantic relationships.

Body Dysmorphic Disorder (BDD)

Individuals with BDD suffer from a preoccupation with the perspective that their appearance or a part of their body is defective, deformed, or flawed. It affects both men and women, and common preoccupations include hair, skin, nose, and legs. In response to their distress, they feel the need to engage in “safety behaviors,” which often involve body camouflaging with make-up or clothing, excessive mirror checking, reassurance seeking, research on how to correct the perceived defect, avoidance of social situations and, in extreme cases, medical procedures and surgery. BDD can cause devastating distress and significant life interference across domains (e.g., financial, emotional, social, and occupational).

Body-Focused Repetitive Behaviors

Trichotillomania is considered an obsessive-compulsive spectrum disorder that involves recurrent and compulsive hair pulling. The pulling often results in hair loss and continues despite repeated attempts to decrease or stop the behavior. Individuals with “trich” often describe significant shame and embarrassment and attempt to hide hair loss with make-up, clothing, wigs or other means. It can include pulling hair from the scalp, eyelashes, eyebrows, pubic area, underarm, beard, chest, and legs, or a combination.

Another BFRB is Skin Picking (or dermotillomania), which involves excessive picking or scratching at skin, including blemishes, scabs/sores, etc. Individuals describe an urge to pick to accelerate healing, achieve “smooth” skin and/or symmetry, or reduce an uncomfortable urge. The compulsive picking, however, leads to damage that is often noticeable, may cause infections or scars, and creates embarrassment and shame. As with trichotillomania, skin picking is believed to be somewhat similar to a motor tic, such as with Tourette’s Disorder, that is difficult for the individual to control.

Tourette’s Disorder or Chronic Tic Disorders

Tourette’s Disorder occurs when an individual has involuntary muscular movements or vocalizations that are called tics. Although this is a neurological disorder, a form of CBT called Cognitive Behavioral Intervention for Tics (CBIT) has been shown to reduce and strengthen management of motor and vocal tics.

Insomnia

Insomnia commonly co-occurs with anxiety and depression. Sleep disruptions include difficulty falling sleep, waking during the night, and/or waking very early. CBT is considered a first line treatment for insomnia and involves assessment of sleep behaviors, modifying sleep habits, and addressing thought patterns that contribute to the insomnia.

Major Depressive Disorder (MDD)

Individuals with MDD experience either persistent depressed mood for at least two weeks and/or a loss of interest in activities. Typical symptoms of MDD include fatigue, concentration difficulties, feelings of hopelessness, thoughts of death or dying, and changes in appetite and sleep patterns. It is not uncommon for individuals suffering from anxiety disorders to develop secondary depression given the negative effects of anxiety on the individual’s quality of life. For children, common symptoms of depression tend to be irritability/aggression, social withdrawal, low self-esteem, and poor school performance.