I was talking to a friend the other morning about a member of her family who has social anxiety. The reason I bring this up is that it got me thinking about the relationship between anxiety and obsessive compulsive disorder. How does “not doing” something because of an anxiety/worry/fear compare to the “compulsions” of OCD? When you think of compulsions, you think of actions: hand washing, checking the front door to make sure it’s locked, using hand sanitizer, counting, touching a certain spot on the wall, etc. But is avoiding something out of fear or because of obsessions also a compulsion in an inside out sort of way? Or is that just straight anxiety?
When I first went to group therapy in Seattle and told my story, I was (nicely) accused of “avoidance.” I had some “anxiety” about driving—worry about hitting cars if I drove or parked too close to them—and I did not like driving in traffic. These worries were a big part of what drove (haha) our decision to move from the (incredibly congested) Bay Area of California to Vashon Island, Washington, where I don’t even think there is a stop light at all. Maybe a flashing red light or two?
I thought that by removing the cause of my anxiety (traffic/crowded roads), I would erase the anxiety as well.
Apparently this is what they call “avoidance.”
The shape shifter
Logically, it made sense to me to avoid “triggers” and thus avoid the anxiety. But the sad thing is, (at least with OCD), it doesn’t work. The OCD doesn’t like to be tiptoed around, at least not permanently. Instead of just bowing out, it comes back in different ways. So you’re not worried about hitting cars? How about germs? Contamination? Getting sick? Not worried about that? Then let’s go back to copyright issues or diet or any host of OCD issues. By avoiding, I may have reduced my compulsions to drive back and check to make sure I didn’t hit cars or to check my car for scratches or dents, but I gained new obsessions and new compulsions that unfortunately made my life even harder to live.
Long story short: avoidance isn’t the answer.
And that’s where the whole idea of exposures and cognitive behavioral therapy comes into play. If avoidance doesn’t work, then what if we make the person be in the uncomfortable situation until they think they can’t stand it and make them do (or not do) that thing they want so badly to avoid?
Long story short: exposure works. Eventually. Usually.
Anxiety? OCD? Both?
So, are anxiety and OCD related? Oh, sure, I definitely think so, but remember OCD doesn’t usually just worry…. Although I have heard some talk of “pure O OCD,” but (in my mind at least) there is some controversy over whether or not you should consider the act of thinking the same thing over and over again and mentally reacting to that in specific, repeated ways to be compulsive. In other words, is there ever really “pure obsession” obsessive compulsive disorder or is a compulsion (physical, mental, emotional or otherwise) lurking around there somewhere and it just isn’t considered to be a compulsion in the classic definition of the word? Does a compulsion have to be a physical action?
That’s a topic for another time.
But generally with OCD, you find that you “must” do things to reduce or calm down that worry. These things don’t really work, of course, and that’s how OCD traps you. For me, I think anxiety can be a precursor to OCD. Maybe I start worrying about something and then my brain clicks into “Aha! But what if you do XYZ? Then it won’t happen!” And if I then do XYZ (over and over again)? Hello compulsions. See what I mean?
But for real, avoid avoidance. It doesn’t help in the long run.