Obsessive-Compulsive Disorder (OCD) is a condition that tends quite commonly to be confused by lay persons with an obsessive-compulsive personality style, which — when severe enough — is diagnosed as a condition called ‘Obsessive-Compulsive Personality Disorder’. OCD is characterised by the experience of obsessions — intrusive thoughts that come into a person’s mind against their will and cause significant distress — and compulsions — repetitive behaviours a person engages in believing that doing so will prevent, or make less likely, what they fear (the obsession).

Obsessions are usually about harm occurring to them or befalling another person — a household appliance (iron, stove, etc.) not being turned off and catching fire, germs on their hands contaminating themselves or someone else, having done something morally wrong such as accidentally hitting a pedestrian with their car, or the back door being unlocked and resulting in an intruder. Obsessions can also be about objects not being in a particular order.

Compulsions do not always have to be a logical behaviour to prevent the feared situation. For example, a person with an obsession about germ contamination may not wash their hands, but instead avoid stepping on cracks in concrete — logically unrelated to the obsession. A person will spend at least one hour of their day engaging in compulsive behaviour; for some, up to three hours or more. Engaging in the ritual temporarily relieves their anxiety, as they feel they have — for now — prevented the harm. They need to fully complete the ritual to feel relieved, and if it is interrupted they will need to start over, which typically causes a lot of distress. For someone who requires quite elaborate rituals, OCD can become psychologically draining and significantly interfere with daily functioning.

Generalised Anxiety Disorder is characterised by excessive worry about daily events. The person finds this worry difficult to control and recognises that it is unreasonable — often saying something like “I know it’s silly to be worrying about this, but I just can’t help it.” They tend to worry about anything and everything: traffic and parking, whether they will finish a task on time, whether they will be late to an appointment, if the kids are okay, the laundry that needs doing, how an upcoming situation will turn out, and much more. People with GAD worry about the same sorts of things as everyone else, but much more frequently, and find it far more challenging to turn the worry off. Because the worry is present much of the time, the body responds with muscle tension, irritable mood, sleep issues, dry mouth and other physical/somatic symptoms. People with GAD present with this level of worry for at least six months or more — though any level of excessive worry is enough to cause most people distress or interfere with their functioning.

Social Anxiety Disorder is anxiety about social situations, where the person fears that others will judge them negatively or that they will embarrass or humiliate themselves in some way. For some, this fear can be so intense that they avoid feared social situations at all costs. If they must enter the situation, they tend to experience high levels of anxiety and try to exit as soon as possible, often relying on a ‘safety person’ — someone they trust and feel comfortable with — to go with them. Commonly avoided situations include shopping centres, parties, the cinema, sporting events and dinner with friends of friends; some people even have significant anxiety about non-face-to-face contact such as phone calls. For some, anxiety can rise so high that they have a panic attack. In our clinical experience, people who experience social anxiety also commonly have low self-esteem and low self-confidence. For some this is chronic, describing themselves as “shy” as a child; for others, self-esteem and confidence were previously good until a negative experience — such as workplace bullying or another personal stressor — led to a shift in thinking and the development of social anxiety. Social anxiety is also commonly associated with depressive symptoms, whether sub-clinical or clinical, in part contributed to by low self-esteem: it can be challenging to feel happy when you frequently don’t feel good about yourself or feel judged by others.

Specific Phobia is where a person experiences anxiety about a specific situation or object. Common examples include confined spaces (claustrophobia), heights (acrophobia), the dark (nyctophobia), spiders (arachnophobia), snakes (ophidiophobia), birds (ornithophobia), blood (haemophobia), and needles or medical injections (trypanophobia), among many others. For some people, simply seeing pictures or photos of the object of their phobia is enough to feel highly fearful. People with a phobia will attempt to avoid the situation at all costs, or otherwise endure it with a lot of anxiety and may even have a panic attack. Phobias can develop in childhood or later in life, and it is not always clear what originally caused them — many people find it difficult to pinpoint when the phobia began, often seeking treatment only after a long time, once they grow tired of living with it. Reassuringly, psychological treatment for phobias is still effective without knowing the specific situation that caused it.

A panic attack is an intensely heightened state of anxiety and fear, beyond that of ordinary heightened anxiety. During a panic attack, a person will feel a range of physiological symptoms, including:

For some people, panic attacks almost always occur in a particular situation (e.g. confined spaces, heights). For others, they come on unexpectedly at any time or place. Because panic attacks can be uncomfortable and frightening — especially when they are new and not yet understood — a person may begin to fear future attacks and avoid situations where one is likely. This is when a person starts to have anxiety about anxiety, known as ‘meta-anxiety’ — the fear of anxiety. Panic attacks can feel as though the person is having a heart attack or is going to die, and the lack of a sense of control over when the next one will come can be distressing. Panic attacks can occur solely as part of a Panic Disorder, or as part of another condition such as Post-Traumatic Stress Disorder (PTSD), social anxiety or specific phobia.

Agoraphobia is where a person avoids situations that cause, or are likely to cause, panic attacks — relating to the fear of panic attacks described above. These people will otherwise endure the feared situation with high levels of distress and try to exit as quickly as possible, or only enter it with a safety person. People with this fear of having panic attacks tend to have an exit strategy in mind before they enter a situation, in case they need to leave immediately.