Signs and symptoms of Anxiety and OCD

Below we have listed some descriptions of the types of issues we specialize in treating at Chicago Counseling Center. While these are common signs and symptoms of various mental health problems, by no means is it an exhaustive list. If you have questions about specific symptoms you may be struggling with that you do not see listed here, please feel free to contact us for further consultation.

General symptoms that could indicate anxiety, depression, or both:

  • Difficulty concentrating/focusing
  • Loss of interest in activities you once enjoyed
  • Increased isolation and decreased desire to interact with other people
  • Sleep disturbances (difficulty falling and staying asleep, difficulty waking up, excessive sleep)
  • Increased irritability, anger, and mood swings
  • “Racing” thoughts that seem difficult to stop
  • Feelings of worthlessness and hopelessness
  • Decreased motivation and/or energy
  • Physical symptoms such as racing/pounding heart, shaking/trembling, dizziness, sweating, shortness of breath, intense headaches that develop rapidly
  • Obsessional thinking/getting “stuck” on one thought/idea that causes distress
  • Avoidance of people, places, and things (including driving, running errands, etc.)
  • Difficulty making decisions
  • Frequent crying spells

Specific Disorders:

Obsessive Compulsive Disorder (OCD):

People with obsessive-compulsive disorder suffer from repetitive unwanted and intrusive thoughts, images, or urges. These obsessions tend to cause high levels of distress, discomfort, and anxiety for the person. It is common for people suffering from OCD to engage in compulsive acts or “rituals” to reduce the distress associated with their obsessions for a brief period; however, those rituals ultimately perpetuate the person’s anxiety as well. Compulsions may be overt (outwardly visible) behaviors, or they may be covert mental rituals such as counting, replacing a “bad” thought with a “good” thought, praying in a certain manner, or mentally reviewing their recent actions to make sure they have not done anything “wrong.” Individuals with OCD often describe feeling as if they have little to no control over these thoughts and behaviors. OCD is also characterized by doubt and difficulty tolerating uncertainty. There are numerous “sub-sets” of types of OCD, but OCD can manifest itself in an endless number of ways. Still, common obsessions include:

  • fear of contamination (dirt/germs, diseases/HIV/STDs, feeling “stained,” feeling “not right,” contaminating others with a negative emotion or thought)
  • thoughts/images of harming others (especially loved ones) or oneself,  commonly referred to as “Harm OCD”
  • unwanted sexual thoughts/images (including loved ones and children)
  • excessively questioning one’s own sexuality, often referred to as “HOCD”
  • symmetry/order, exactness, things have to be “just right”
  • unwanted religious thoughts, fears of saying/doing something blasphemous
  • excessive doubting, questioning numerous things and/or everything
  • unreasonable and unjustified doubts/fears about intimate relationships, often referred to as “Relationship OCD” or “rOCD”
  • not feeling “just right” about numerous (or single) thoughts, objects, emotions, or body sensations

Common types of rituals may include:

  • hand washing, excessive showers/bathing, excessive cleaning, avoiding others and places for fear of contamination
  • excessive checking (physical or “mental checking”/self-reassurance)
  • arranging or ordering things until they feel “just right”
  • praying or mental compulsions like replacing or “neutralizing” a bad thought with a good thought
  • mentally reviewing situations, mentally retracing steps and past actions
  • continually searching for answers and trying to “figure it out”
  • checking one’s own feelings to see if they are “right”
  • repeating (e.g., erasing, re-ordering or adjusting, re-reading)

Generalized Anxiety Disorder (GAD):

Individuals with GAD experience excessive worrying about multiple different things, more days than not, to the point that it may interfere with their physical and mental health. The chronic worry creates significant anxiety and physiological sensations (e.g., stomach distress, muscle tension, fatigue, heart palpitations, irritability, etc.). Individuals with GAD typically worry about topics that are concerns shared by most people but have difficulty turning off a worry and often spiral to imagining the worst-case scenario. Individuals with GAD often experience sleep difficulties (falling asleep, waking up frequently) secondary to the physical sensations brought on by worry. Individuals with GAD may have trouble trying new experiences (travel; recreational/social activities) as they have difficulty tolerating the uncertainty of not knowing exactly what to expect and/or how to “control” the situation.

Social Anxiety (or Social Phobia):

Individuals with social phobia are excessively concerned with the negative judgment of others. While they remain interested in social connections, they tend to avoid social interactions to reduce their distress and discomfort. The vast majority of adults with social phobia report having experienced this worry for as long as they could remember, and typically describe having been shy and quiet during their school years. Physical sensations accompanying anxiety (such as stomach upset, difficulty concentrating, shaking, voice trembling, and blushing) can increase fear and embarrassment in social situations. Most adults and children with social anxiety find it difficult to initiate conversations, express opinions/be assertive, speak in groups, make eye contact, tell jokes, and take risks, particularly in dating situations. In the worst cases, people with social anxiety become very isolated and depressed. In some cases, individuals with social anxiety will overextend themselves socially in order to please everyone. These people appear socially comfortable and connected, but express very little social enjoyment due to their constant need for approval by others.

Panic Attacks and Panic Disorder with Agoraphobia:

Panic attacks are common in all anxiety disorders and in the general public (approximately one-third of the population has had a panic attack in the past year). However, those who suffer from panic disorder have persistent fear of having a panic attack in a situation in which they cannot escape or get help. A panic attack is defined as the emergence of four or more physiological sensations (e.g., heart race, dizziness, light-headedness, stomach distress, trembling, feelings of derealization) peaking in intensity within 10 minutes. Those with panic disorder typically fear a catastrophic outcome from panic attacks; for example, I am going to lose control of myself, I am going to die, I am going to go crazy, and/or I am going to embarrass myself. Often, people with Panic Disorder tend to avoid situations that might elicit a panic attack (called Agoraphobia). Examples of avoided situations: locations (airplanes, traffic, large open spaces); foods (caffeine, sugar, alcohol); emotions (excitement, anger, anxiety); and activities (exercise, sex).

Health Anxiety:

Individuals with health anxiety have an excessive fear of illness and/or death. Frequently, these individuals engage in excessive health safety behaviors such as scanning their body for symptoms or seeking excessive reassurance from loved ones and health professionals regarding their health status. Despite these efforts, they rarely find relief. While some individuals with health anxiety may constantly research their perceived symptoms and/or illnesses (online searches, frequent doctor’s visits), others may excessively avoid health information and health professionals to magically prevent illness. Individuals with health anxiety feel more vulnerable to disease, and, as a result, are intolerant of uncertainty regarding diseases and illness.

Specific Fears/Phobias:

A specific phobia refers to the excessive and persistent fear of specific objects or situations that is understood as out of proportion to any actual danger. The fear causes life-interfering distress and/or impairment. Common types include:

  • Animals (e.g., dogs, cats, spiders, insects, rats, birds, and snakes)
  • Natural Environment and Weather (e.g., heights, storms, natural disasters, and water)
  • Blood-Injection-Injury Type (e.g., seeing blood, receiving a blood test or injection, watching medical procedures)
  • Situational Type (e.g., driving, flying, elevators, and enclosed places)
  • Other Type (e.g., choking or vomiting, loud noises, or fears of costumed characters)

Post-traumatic Stress Disorder (PTSD):

PTSD is an anxiety disorder that can develop following a traumatic event (i.e., exposure to a threat to the physical safety of self or others–either experiencing the threat directly or witnessing the threat to another). The traumatic event is experienced with a sense of intense fear, horror, or helplessness. In children, the reaction involves disorganized or agitated behavior. Symptoms of PTSD include:

  • re-experiencing the trauma (i.e., flashbacks, nightmares, recurrent intrusive thoughts)
  • hyperarousal (i.e., feeling jumpy or easily startled, difficulty sleeping and restlessness, irritability, difficulty concentrating, and hypervigilance or feeling on guard all the time)
  • avoidance (i.e., avoiding places, people, events, or objects that remind a person of his or her trauma, emotional numbness, loss of interest in previously-enjoyed activities, difficulty remembering important aspects of the trauma, feeling cut-off from people)

Many individuals experience a few of the symptoms described above following a trauma. However, a person develops PTSD when these symptoms last more than one month and become life-interfering. In some cases, it can be months or years following a trauma before symptoms emerge.

PTSD symptoms can arise in people of all ages who have experienced a traumatic event; however, symptoms may appear differently in children compared to adults. Younger children may develop the following symptoms: repetitively acting out the event during play, separation anxiety, decrease in speech, bedwetting, and/or stomachaches and headaches. Symptoms in teenagers are more likely to resemble those of adults but may also include disruptive and destructive behaviors. In addition to the symptoms described above, those with PTSD often have emotional reactions such as anger, guilt and shame as well as disruption in sleep, diet, and exercise habits.

Separation Anxiety Disorder:

Children, teens, and adults with separation anxiety typically fear being away from loved ones and/or home. Common worries of separation include harm to themselves or loved ones as well as fears of having uncomfortable sensations associated with anxiety (e.g., stomach distress) or illness while away. While the worry of separating can occur during daytime activities, anxiety tends to escalate around nighttime and during extended trips. Some children will exhibit oppositional behaviors (e.g., meltdown, tantrums, aggression) in an effort to avoid leaving parents/home. Separation anxiety can interfere with social relationships given reluctance to enter new social situations that require temporary separation from loved ones.

Major Depressive Disorder (MDD):

Individuals with MDD experience either loss of interest in pleasurable activities and/or persistent sadness for at least two weeks. Almost 15% of U.S. adults report that they experienced a major depressive episode at some point in their lives. Typical symptoms of MDD include fatigue, concentration difficulties, feelings of hopelessness, thoughts of death or dying, and changes in appetite and sleep patterns. However, individuals with MDD can endorse numerous additional symptoms including anxiety, physical pain, and extreme social sensitivity. It is common to develop depression secondary to a severe anxiety disorder. Common symptoms of depression seen in children are irritability/aggression, social withdrawal, low self-esteem, and poor school performance.

Impulse Control Disorders:

Clients suffering from impulse control disorders experience a strong uncontrollable urge in their body and relieve it by engaging in repetitive body behaviors. One out of 20 people report engaging in repetitive body-focused behaviors including scab picking, nail biting, and knuckle cracking. However, clients with Repetitive Body Focused Disorders (RBFD) report weak control over these urges and behaviors, excessive distress, and significant life interference.

Trichotillomania, or hair pulling, is a very common RBFD. Clients with trichotillomania will pull hair from any site on their body, but the most common sites include eyelashes, eyebrows, scalp hair, underarm and pubic regions, and arm and leg. Individuals with trichotillomania have noticeable gaps or patches in hair growth. Pulling behavior can be focused (with awareness) or automatic (without awareness). The behavior can be experienced as soothing in the moment but can lead to feelings of shame and anxiety. For some people, the pulling ritual includes examination of hair and root, as well as root chewing. Pulling behavior may be triggered by a variety of emotions (e.g., stress, anxiety, anger, boredom), situations (e.g., work, T.V., driving, falling asleep), or contexts (e.g., seclusion, mirrors, grooming).

Skin Picking is an impulse control disorder in which people excessively pick or scratch at their blemishes, scabs/sores, etc. Individuals with skin picking often pick to accelerate the healing of a blemish, achieve symmetry, or soothe an uncomfortable urge. Most individuals will describe feeling out of control or “once I start, I can’t stop.” The damage to skin is often noticeable and leads to embarrassment and shame. As a result, individuals with skin picking will typically attempt to conceal the skin picking sites.

Body Dysmorphic Disorder (BDD):

People with BDD suffer from the obsession that a part of their body is defective, deformed, or flawed. All parts of the body are susceptible, but common sites include hair, skin, nose, and legs. Clients with BDD engage in a number of safety behaviors to relieve their distress including body camouflaging with make-up or extra clothes, excessive mirror checks, reassurance seeking from loved ones, research on how to correct the perceived defect, avoidance of social/public gatherings and, in extreme cases, surgery. Clients suffering from BDD can experience significant life interference on every level (e.g., financial, emotional, social, and occupational). Although BDD affects a percentage of the population similar to other anxiety disorders, it’s not a widely recognized condition. BDD should not be confused with body image dissatisfaction that many people and individuals with Eating Disorders struggle with; in general, individuals with BDD are overly focused on a specific body part vs. their weight.

Binge Eating Disorder (BED):

Binge Eating Disorder may also be referred to as “Compulsive Overeating” or “Emotional Overeating,” and it is now the most common form of eating disordered behavior in the United States. BED is characterized by consuming a large amount of food within a very short period of time (for example, 3-4 meals-worth of food in less than 10 minutes, etc.). People who struggle with Binge Eating sometimes describe feeling as though they “black out” during a binge episode and are not fully aware of the amount they are consuming or how quickly they are consuming it. Binge Eating is typically a behavioral response to “numb out” or decrease the intensity of unpleasant feelings, thoughts, and memories. Binge Eating is an especially dangerous behavior because it can lead to numerous physical and medical complications for the person.