Common factors in Panic, OCD, and Phobias
OCD, Panic Disorder, and Phobias are different diagnoses in the DSM-V, but they often travel together - why? First let’s define:
OCD
A pattern of intrusive thoughts, sensations, or images that are distressing and unwanted (obsessions), followed by a coping strategy of compulsions, which are attempts to neutralize, distract from, avoid, or compensate for the obsessions. The obsessions and compulsions are happening frequently enough to cause distress and negatively impact life.
In short, this is fear of intrusive thoughts, coupled with avoidance strategies.
Panic Disorder
Panic Disorder is a pattern of avoidance and preoccupation following a panic attack. Panic attacks are experiences of being “out of control,” in which the following symptoms arise: racing heart, racing thoughts, sweating, thoughts, feelings sensations of “not being real” (surreality), dizziness, nausea, rapid breathing. Although panic attacks are short lived experiences, when a person is in them, it is common for the person to believe that the feelings will never end or that they will lead to death. These are powerful thoughts and feelings, even though panic attacks are not physically dangerous. Some people categorize panic as a state of “fight, flight, fawn, or freeze” in which they feel they don’t direct their own actions.
In short, panic disorder is fear of physical sensations of fear, coupled with avoidance strategies
Phobias
Phobias are an extreme aversion and avoidance of specific situations or things (ie needles, bridges, vomiting, the dentist).The process causes distress or other negative impacts to daily living.
In short: Fear of something specific + avoidance strategies
Common factors:
Fear + avoidance = more fear and more avoidance.
This is a recipe for making more and more decisions based on fear, and avoiding more and more things “just to be safe.”
With all three of these conditions, there are similar patterns of belief, process, and behavior.
The most extreme version of the belief chain sounds something like:
A horrible thing happened (or might happen). I cannot ever handle that happening again. All other experiences with that thing are irrelevant except the horrible experience. The only way to stay safe is to avoid. Nothing matters more than staying safe and avoiding.
There are many verifiable elements of this belief that are not worth struggling with. Indeed your experience was horrible. Indeed we are wired for safety. It is true that avoidance will keep you from that thing. There are some interesting judgment calls here though:
The horrible experience or thought is more memorable, but that doesn’t make it more true. This is the illusion of memory - we hold on to our most emotional experiences most tightly.
The difficulty you had with that experience doesn’t mean that you will never be able to handle it in the future. We just can’t tell the future.
There may be things that matter more than avoiding your pain. For example if avoidance meant that you didn’t eat or have any friends, you might be threatening or shortening your life through avoidance.
There may be ways to stay safe without avoiding. The only way to know this is to try the other options.
It may actually not always be within your control whether you stay away from that thing you fear.
The feedback loop of these conditions:
OCD, Panic, Phobia cycle
Three new problems arise from avoidance strategies that weren’t there before:
The disturbing thoughts and sensations don’t go down over time. You start to need more avoidance and compulsions to feel safe.
You start to shrink your life, which narrows your perspective and can take away experiences that used to buffer you from the hard stuff.
You lose many opportunities to build skills, which makes you less skilled, which makes you doubt yourself more, not less.
What might be some of the vulnerabilities being revealed here?
People who experience OCD, Phobias and Panic may be more sensitive, meaning they may sense their internal world and physical experience more intensely than a majority of people, or have differences in their sensory processing that cause them to doubt their own experience.
see: The-relationship-between-sensory-processing-childhood-rituals-and-obsessive-compulsive-symptoms
People who experience OCD, Phobias, and Panic, may have what’s called “attenuated access to internal states,” meaning a difficulty discerning information from their sensory experience in order to make decisions. This article discusses the “proxy process,” in OCD, in which a mental checklist process is used and often repeated in place of sensed information, to make a decision.
People who experience OCD, Phobias and Panic may have particularly vivid imaginations, thus thoughts, predictions and internal experiences.
People who experience OCD, Phobias and Panic may be more protection-oriented and more risk averse.
These vulnerabilities are morally neutral. There is nothing inherently wrong with being sensitive, imaginative, and risk averse. It may indicate that you need more strategies to regulate your sensory system, more creative outlets, and support to face risks.
Well-studied therapies (ACT and ERP) for OCD, Panic, and Phobias agree that the treatment strategy for these 3 conditions is the same. We skill up and start approaching what matters even though fear is present. We accept discomfort and see what is possible besides avoidance.
It is within reach to live a joyful and satisfying life with OCD, Panic, and Phobias. The lucky majority of people without these conditions maintain their emotional regulation without having to think about all the possible ways things can go wrong. They get to take safety for granted. If you work through your fears, you may end up stronger and better prepared to face the world than those who don’t.
However, it is common to need some help getting out of the feedback loops that keep them going.
For compassionate and effective therapy for OCD, Panic, and phobias, contact me here.
