Plagued by anxiety: For some of us, no end of things to worry about
It didn't matter what we officially called it, my psychiatrist said as he looked up from his notepad. What I had was “worry in search of a mission.”
Within 40 minutes of speaking with me, he'd learned enough to accurately describe the private struggle that had defined my life.
Technically, there were names for what I had, at least according to the Diagnostic and Statistical Manual of Mental Disorders: obsessive-compulsive disorder and generalized anxiety disorder.
But, as my psychiatrist told me, these labels were most helpful for research purposes. You could, he said, drive a truck through psychiatric diagnoses. And, throughout the stages of an individual's life, the diagnosis can change.
Early signs
My anxiety started when I was in third grade.
I stood alone at the bus stop with a battery-powered travel alarm and two watches. I checked them frequently as I looked for the yellow bus to appear, fearing that it never would. My teacher called me a worrywart and my parents thought I was eccentric. No one thought I needed help.
When I was older, AIDS snatched the life of a beloved teacher, and I privately feared that disease and death could jump out from the dark. Instead, it was two men with a gun on a lonely subway, a mugging that made me susceptible to panic attacks in tunnels and dark theaters.
There were other moments that convinced me that life could suddenly go from safe to dangerous.
That sunny day at work in September 2001, for one, when I watched the planes hit the towers and thought about the split-second decision I made earlier to not head downtown and vote.
But I didn't need the prospect of large-scale terrorism to drive me into obsessive worry.
No, I could find the possibility of disaster in much smaller moments: Was a fever a sign of meningitis? Did the pharmacist give me the wrong medication? Did I hit someone while daydreaming as I drove home and somehow not even notice?
Such intrusive thoughts are a mark of obsessive-compulsive disorder.
It was after a doctor discovered a blue-and-green mole during an annual pelvic exam that I began to exhibit the other classic trait of OCD: repeated actions.
For me, this meant checking my skin for signs of trouble. I'd check. I'd ask my husband to check. I'd go to dermatologists to check. And then I'd do it all over again.
At my peak, I went to three dermatologists four times a year, convinced that each of them had failed to spot a lurking cancer. Between visits, I was absorbed in what-ifs, and I was never without worry.
Facts about OCD
About 2.2 million American adults are affected by OCD, according to the National Institute of Mental Health. About half of those cases are so severe that an individual's ability to go to school, go to work or otherwise function in life is significantly affected.
OCD is often associated with anxiety, of which generalized anxiety disorder is a part. Many people with OCD have intrusive thoughts — ideas that are disturbing and alien.
Then there are the compulsive behaviors, such as washing one's hands multiple times an hour or going to check that the iron is off. These serve to decrease anxiety or manage the intrusive thoughts. But, in fact, they offer short-term relief and only encourage a compulsion and anxiety.
A turning point
As I try to make sense of my relationship with anxiety and OCD, I think of a particular day when I was 17, just two years shy of the average age for onset.
It was an important day for me. I was scheduled to videotape two monologues for an acting competition. Before that, I had to shower and get ready.
I still remember the water beating down on me in the tiny stall and sitting on the black tile crying. Something inside was changing. Was it fear? Was it anxiety?
Whatever it was, it would follow me to college, graduate school and auditions in New York. For years, I always had the sense that I was trying to regain the freedom that slipped down the drain on that fall day.
It's hard to put a quantitative measure on the decline or failure in one's ability to do a creative task. It's not something that can be captured in points scored or races won. But as a young adult I flopped in auditions; I turned down roles I was offered, and I no longer found joy in the process of discovery and invention that had once been my favorite activity in the world.
If I had been slowly succumbing to anxiety's hold, my decline gained speed after I was mugged at gunpoint on the way home from an acting class. I immediately signed up for a course in self-defense, and then several in journalism. I said goodbye to theater and hello to a job in news.
There were other changes in vocation and in how I managed my anxiety. Some might be attributed to factors that influence many people's lives: marriage, children, moves and an attempt to be flexible. I switched to teaching, and eventually to writing. And in many ways, I was always normal enough. I could leave the house, do my work, care for my children and socialize with friends. But my worries were never put to rest, and in my mind they were always justified.
It's possible, I figured, that the dermatologist missed that one mole on my ankle and that I needed a second opinion. It's possible that the new baby sitter is actually a child abductor and she's driven the kids across state lines. It's possible that I left the stove on. It's possible that the plane's engines have failed and the flight attendants are pretending everything is OK, but we're all about to die if I don't keep worrying about that sound I heard 10 minutes ago.
Seeking help
It was my husband, a calm and steady guy, who finally said he wasn't going to put up with my need for constant reassurance. And most of all, he didn't want the kids to grow up in an environment of anxiety.
When he cut the emotional tether, I considered my options.
First, I envied a friend who was married to a dermatologist. She was so lucky to always have someone in the house who could examine an atypical nevus anytime she wanted. And wouldn't it be great if I knew more commercial pilots? All I needed was a friendly voice from the cockpit now and then to let me know not to worry, and I'd be fine.
Fortunately, I realized that if my private torture was now affecting my husband and potentially my children, I needed real help. And I needed to make progress.
The first thing I did was look at the list of doctors within my insurance network's mental health plan. Many focused on addiction or were in rehabilitation facilities. Some were far away. Others had degrees from universities I had never heard of. I'd briefly been to one therapist on the list; I wasn't convinced a second attempt would be much more successful. So I asked for recommendations from a friend whose husband had a debilitating form of OCD. And I asked a trusted physician, the one who delivered my first baby.
Both told me how the industry worked: The psychiatrist I needed wasn't going to be in a network.
That is, perhaps, one of the most controversial statements I can write in this essay as we deal with the larger issue of mental health care in this country. I am not in a position to say if it is a fact that the care I needed would not be found in my network of providers. But at the time, like many women, I was both the patient and the caretaker, so to speak. I didn't have any energy to interview a swath of potential doctors. My OB gave me a name. He was supposedly a very good psychiatrist. He would be expensive. And it would be a month before he could see me.
This doctor knew his stuff. And he was precise. This was not about talking it out or unraveling my childhood. This was about brain chemistry.
He ordered a blood test to check my liver and thyroid, a precaution he takes before prescribing medication. He started me on a small dose of an antidepressant commonly prescribed for depression and for anxiety. We scheduled a phone call to check in within a week, and follow-up appointments for the next month and beyond.
Meanwhile, I would meet with the psychiatrist's colleague, a social worker who would offer cognitive and behavioral strategies.
Medication and therapy
This combination of medication and cognitive behavior therapy is the best treatment for OCD, according to clinical psychologist Felix Vincenz, an expert in the field and associate director of the Missouri Institute of Mental Health.
My cognitive behavior therapy involved doing what you might find absolutely normal: wearing a regular swimsuit to the pool. I could not hide beneath a full-body rash guard anymore. At first, I had to expose my skin for only five minutes or only one or two days a week. I could still use sunscreen, of course. I still wore my hat, and I could still go to a dermatologist, but only one doctor, and only every six months to a year.
Through this process of letting go of my compulsive behavior, I learned that nothing terrible happened as a consequence. I learned to interrupt the impulse to cover up and to check my skin and have a doctor check it.
Things improved quickly.
After about a month, I had the feeling that the elevator in my mind, the one that used to shoot to the top floor of anxiety with the slightest provocation, now hovered somewhere in the middle. I was more able to live in the present moment instead of being tangled up in thoughts about death or disaster or failure. I went back to yoga, no longer finding anxiety in moments of quiet or trepidation in the shower, a place that once tempted me to look for malignant moles.
I got on a plane without weeks of anticipatory anxiety. And I have now learned how to live with my overactive “reptilian” brain, thanking it for wanting to protect me with worries and fears, but asking it to take a break.
I'd been in therapy as an adult before. There was the 93-year-old disciple of Anna Freud who told me my skirts were too short; then the kind but ill man who died a few weeks after I began seeing him; then his replacement, whose office was in a rundown hotel; and then the psychologist with whom I talked but made no progress.
I credit my husband for his tough love; my psychiatrist and social worker for their comprehensive care; and the friend who had been through hell and back with her husband for giving me blunt advice. And I look at my family history and the choices not taken because of anxiety, and I feel fortunate that I live in this moment, when the suffering might be eased with less stigma, more-appropriate medication and an awareness of lifestyle changes that can support progress.
It is embarrassing to share my private struggle, but not so embarrassing that I don't want someone else to learn from it that there are ways to ease the burden of anxiety and OCD.
I will admit that new fears creep in, especially recently. But I am aware of my tendency for catastrophic thinking and for channeling a worry into a compulsion. I don't want to go there again. I know now that there is an alternative.
Progress and the future
A few months into the therapy, we packed up the car and pulled out of the driveway to set off on a 900-mile drive. My husband turned to me and said, “That was the first time since we've been married that you didn't get upset about how I loaded the car.”
You see, it was never about the car.
Or the stove.
Or the mole.
But it was always about letting go.
Understanding anxiety
The National Institute of Mental Health offers more information about anxiety disorders at nimh.nih.gov.
<b>Generalized anxiety disorder</b>The website describes these signs and symptoms of generalized anxiety disorder, or GAD:
• People with GAD can't seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants.
• They can't relax, startle easily and have difficulty concentrating.
• Often they have trouble falling asleep or staying asleep.
• Physical symptoms often include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, hot flashes and feeling out of breath.
• GAD develops slowly. It often starts during the teen years or young adulthood. Symptoms may get better or worse at different times, and often are worse during times of stress.
• When their anxiety level is mild, people with GAD can function socially and hold down a job.
• Although they don't avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe.
<b>Obsessive-compulsive disorder</b>As for obsessive-compulsive disorder, the institute says that people with this condition generally have repeated thoughts or images about things such as germs, dirt or intruders; acts of violence; hurting loved ones; sexual acts; conflicts with religious beliefs; or being overly tidy. In addition, some people with OCD:
• Do the same rituals over and over, such as washing hands, locking and unlocking doors, counting, keeping unneeded items or repeating the same steps again and again.
• Can't control their unwanted thoughts and behaviors.
• Don't get pleasure when performing those behaviors or rituals, but do get brief relief from the anxiety that the thoughts cause.
• Spend at least an hour a day on the thoughts and rituals, which cause distress and get in the way of daily life.
<b>Ways to help</b>Mental Health First Aid, a program coordinated by the National Council for Behavioral Health and the Maryland and Missouri health departments, is an eight-hour course that gives people the skills to help someone who is developing a mental health problem or experiencing a mental health crisis. The website is mentalhealthfirstaid.org/cs.
<b>Myth vs. reality</b>The Anxiety and Depression Association of America has compiled a list of myths about anxiety with an accompanying reality check at its website at aada.org. (Click on “understanding the facts.”)