Place Of OCD In The Anxiety Disorders

Anxiety disorders are a class of their own in all psychiatric disorders. At this point it is useful to list the anxiety disorders, with a brief description of what symptoms they represent.

• General anxiety disorder (GAD): here the patient suffers from chronic anxiety that is not focused on any specific person, object, or event. GAD is often seen in older adults; a general insecurity about life and its limits may be involved;
• Panic disorder (PD): this consists of brief attacks of intense anxiety, which come with distinct outward signs: trembling, shaking, and confusion are present. The person may experience a deep foreboding of something terrible to happen (e.g. a heart attack). Even in more peaceful periods, the subject may get frightful about a next panic attack on the horizon, for instance if the heartbeat increases for a brief time;
• Phobias: these are disproportional fears about a certain situation, a place, certain types of animals, social situations, bodily fluids – the list is endless. Well-known phobias are agoraphobia (fear of wide open spaces); claustrophobia (for narrow, small spaces, e.g. an elevator); arachnophobia (for spiders); and social phobia, or social anxiety disorder (SAD). I want to emphasize that especially SAD potentially is a huge threat to a person’s quality of life: avoidance behaviour (not wanting to speak in public, evading attempts to make intimate contact by the other sex) can have a very damaging effect;
• Post-traumatic stress disorder (PTSD): this anxiety disorder has its roots in a traumatic event, e.g. severe childhood abuse (sexual or otherwise), rape, and war experiences. PTSD can be triggered by environmental cues that remind the patient of a particular trauma, and then flashbacks may occur: the actual ‘inner re-living’ of that terrible event. Avoidance behaviour, extreme vigilance, insomnia, fear, anxiety, anger and depression are often seen in PTSD patients;
• Separation anxiety disorder (SepAD): this is excessive anxiety about getting separated from a person or a place. For babies and children it is a normal phase in their development (transitional), but it can be very severe. In adults, some 7% of all people suffer from SepAD, and here it is really an impairment of the quality of normal life.
• Childhood anxiety disorder: here there is extreme anxiety and nervousness about different situations, especially about encountering new experiences. Now, a certain level of arousal and fear is normal, but if fear is disproportional and assumes a chronic character, then it can seriously hamper normal development of a young person. Avoidance and indecisiveness are potentially a threat to cognitive abilities, adjustment to a new environment, learning, and emotional development. Even hyperventilation, diarrhoea, ulcers and stomach problems can present themselves; and self-criticism, irritability, insomnia, and a lack of the will to live (in older children) all can occur.

This list is based on the textbook Principles of Neural Science by Eric R. Kandel et al (McGraw-Hill publishers, 4th edition, 2000); and it was expanded by using Wikipedia as the second source (lemma: ‘anxiety disorders’).

I will leave the reader with a photo of a very famous painting by expressionist painter Edvard Munch, who went through severe episodes of anxiety himself. It it titled: ‘The Scream’, and was painted in 1893. It is exhibited in the National Gallery in Oslo, Norway.