All anxiety disorders share the symptoms of anxiety/fear and worry.

Fear is the primary symptom across all anxiety disorders and it originated from the overactivation of the Amygdala (it looks like an almond).

• It processes all the sensory information way before your awareness or realization of them because it needs to detect if there are any survival-related threats in the environment. If there is, then you have fear.

• Fear is not just an emotion, it can also be an action, including fight, flight, or freeze.

• Along with periaqueductal gray area (PAG), you have avoidance behaviors. It includes avoiding getting out of the comfort zone, generating and avoiding catastrophizing results, and phobic avoidance.

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Social Anxiety

• How does it feel like to have social anxiety?

  Imagine that you are going to a party or social gathering where you don't know many people. As you walk into the room, you immediately feel a sense of dread wash over you. You start to feel your heart racing and your palms sweating. You can't help but worry about how others will perceive you, whether you'll say something stupid, or whether people will find you boring or unlikeable.

  As you scan the room, you notice that everyone seems to be having a good time and engaging in conversation. But you feel paralyzed and unable to join in. You might find yourself standing awkwardly by the wall, trying to blend in with the wallpaper, or you might make a beeline for the bathroom, hoping to avoid any social interaction.

  Even when you do manage to engage in conversation, you might feel like you're constantly second-guessing yourself. You worry about whether you're saying the right thing, whether your jokes are funny enough, or whether you're making a good impression. This constant self-monitoring can make it difficult to enjoy yourself or be present in the moment.

  Social anxiety can also affect other areas of your life. For example, you might dread going to work or school because of the social interactions involved. You might avoid making phone calls or sending emails, or you might decline invitations to social events altogether. It can make you feel isolated, self-conscious, and afraid of judgment.

• How to understand it from the brain's perspective?

  • Amygdala: The amygdala is an almond-shaped structure in the brain that plays a key role in processing emotions, especially fear. Research has shown that individuals with social anxiety disorder have an overactive amygdala, which contributes to their heightened anxiety in social situations.

  • Prefrontal Cortex: The prefrontal cortex is the part of the brain responsible for executive functions, such as decision-making and self-control. Research has shown that individuals with social anxiety disorder have a decreased activity in the prefrontal cortex, which contributes to their inability to regulate their anxiety in social situations.

  • Hippocampus: The hippocampus is an important structure in the brain that is involved in regulating stress and anxiety. Research has shown that individuals with social anxiety disorder may have a smaller hippocampus, which can contribute to their heightened anxiety in social situations.

  • Neural Circuitry: Social anxiety disorder is thought to involve altered neural circuitry in the brain. Research has shown that the brain circuits involved in fear, anxiety, and social cognition are altered in individuals with social anxiety disorder, which can contribute to their increased fear and anxiety in social situations.

  • Cortisol Feedback Loop: Research has shown that individuals with social anxiety disorder may have a disrupted cortisol feedback loop, which contributes to their heightened anxiety in social situations. Cortisol is a stress hormone that is released in response to anxiety and stress, and in a typical feedback loop, cortisol levels should decrease once the stressor has been removed. However, in individuals with social anxiety disorder, cortisol levels may remain elevated, leading to continued feelings of anxiety and fear.

  • Autonomic Nervous System: The autonomic nervous system, which controls functions such as heart rate, blood pressure, and sweating, is also thought to play a role in social anxiety disorder. Research has shown that individuals with social anxiety disorder may have an overactive autonomic nervous system, which can contribute to physical symptoms such as sweating, shaking, and rapid heartbeat in social situations.

  • Neurotransmitters: Research has also shown that there may be an imbalance of neurotransmitters in individuals with social anxiety disorder, which can contribute to their increased anxiety and fear. For example, low levels of the neurotransmitter GABA and serotonin, which regulates anxiety, have been observed in individuals with social anxiety disorder.

Somatic symptoms are the physical results of Fear and Worry and they are across your whole body.

• Muscle: Pains and aches, twitching, stiffness, sudden muscle jerks, grinding of teeth, unsteady voice, increased muscular tone.

• Skin: Tinnitus, hot and cold flushes, feelings of weakness

• Heart: fast heartbeat, heavy heartbeat, pain in chest, dizziness or fainting feelings

• Breath: pressure in the chest, choking feelings

• Stomach: abdominal pain, nausea, vomiting

• Urinary: frequent peeing, disrupted periods

• Other reasons that can cause the anxiety

• Childhood Experiences: Childhood experiences such as bullying, social exclusion, or criticism from family or peers. Accused of being different such as having a shy personality, behaviors, race, ethnicity, hobbies, body image issues, being part of LGBTQ group, and others.

• Traumatic Experiences: Experiencing traumatic events, such as verbal, emotional, physical, or sexual abuse.

• Perfectionism: Growing up in an environment where high expectations and a need for perfection are emphasized, you may feel pressure to constantly perform well and avoid making mistakes in social situations.

• Cultural and Societal Factors: Certain cultural and societal factors, such as a lack of social support or a focus on individualism.

• Social isolation: Social isolation refers to a lack of social connections and a limited number of social relationships due to objective or subjective reasons such as quarantines during COVD. Individuals who do not have a social anxiety disorder may develop it due to isolating themselves from others. It can decrease your social skill level and your previously formed social comfortability. It also reinforces anxiety for those who already have social anxiety, as they receive less positive social feedback and have fewer opportunities to practice their social skills.

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OCD

• Do you have these experiences?

  • Contamination and cleaning obsessions: Fear of contamination from germs, dirt, viruses, etc. Compulsions: Excessive cleaning, hand-washing, avoiding public places or objects, using gloves or masks, etc. Example: Repeatedly washing one's hands for hours after touching a doorknob.

  • Checking obsessions: Fear of harm, danger, or losing control of oneself or one's environment. Compulsions: Checking and rechecking doors, windows, locks, appliances, switches, etc. Example: Checking the front door several times to ensure it's locked before leaving the house.

  • Symmetry and ordering obsessions: Preoccupation with symmetry, orderliness, and perfectionism. Compulsions: Arranging and rearranging objects, counting or organizing items in a particular way, ensuring everything is in a specific place or pattern. Example: Spending hours arranging books on a shelf so that they're all perfectly aligned.

  • Hoarding obsessions: Fear of losing something valuable or important. Compulsions: Collecting and keeping unnecessary items, difficulty discarding things, excessive buying and saving of objects. Example: Accumulating piles of newspapers and magazines that are no longer useful.

  • Intrusive thoughts obsessions: Inappropriate or taboo thoughts, images, or impulses that are unwanted and cause extreme distress. Compulsions: Mental rituals, repetitive behaviors or actions, seeking reassurance, avoidance of triggers, etc. Example: Constantly worrying about accidentally harming someone, such as pushing someone in front of a train.

  • Just-right OCD: Obsessions: A sense of discomfort or incompleteness unless things are done "just right" or in a specific way. Compulsions: Repetitive behaviors to achieve the feeling of "just right," such as tapping, counting, or touching objects in a particular sequence. Example: Feeling compelled to redo a task multiple times until it feels "just right."

  • Mental contamination obsessions: Feeling contaminated or "dirty" from a thought or memory. Compulsions: Mental rituals, such as praying or reciting a phrase, or avoidance behaviors. Example: Avoiding a certain word or thought because it feels "unclean."

  • Sensory OCD: Obsessions: Sensory discomfort, such as a fear of unpleasant tastes, smells, or textures. Compulsions: Avoiding sensory triggers or seeking reassurance that sensory experiences are safe. Example: Refusing to touch certain objects because they feel "gross."

  • Harm OCD: Obsessions: Intrusive thoughts or fears of causing harm to oneself or others. Compulsions: Checking and rechecking behaviors, avoidance of potential triggers, and mental rituals. Example: Avoiding driving because of intrusive thoughts of causing an accident.

  • Relationship OCD: Obsessions: Fear of losing a relationship or not being good enough in a relationship. Compulsions: Seeking reassurance from the partner, excessive monitoring or checking behaviors, and mental rituals. Example: Constantly checking if the partner is happy with the relationship.

• How to understand it from the brain's perspective?

  • The basal ganglia, which is a group of nuclei located in the subcortical part of the brain, is thought to play a key role in regulating repetitive, compulsive behaviors seen in OCD. It’s thought to act as a filter for incoming sensory information, allowing relevant information to pass through to the cortex while suppressing irrelevant information. In individuals with OCD, there is evidence of hyperactivity in the basal ganglia, which can result in the development of intrusive thoughts and compulsive behaviors. This hyperactivity can interfere with the normal filtering function of the basal ganglia, causing intrusive thoughts and compulsions to persist despite the individual's efforts to suppress them.

  • The anterior cingulate cortex is involved in the regulation of emotions and the processing of conflict and error signals. In individuals with OCD, there is evidence of decreased activity in the anterior cingulate cortex, which can cause you to feel “something is wrong” all the time no matter how many times you repeat thinking about it obsessively or do it compulsively.

  • The orbitofrontal cortex is a region of the brain located in the frontal lobe just above the orbits (or eye sockets) that is involved in the regulation of emotions and decision-making. In individuals with OCD, there is evidence of decreased activity in the orbitofrontal cortex, which makes you “lose the ability to stop” your obsessive thoughts and compulsive behaviors.

  • The thalamus is a structure that serves as a relay station for sensory information in the brain. In individuals with OCD, there is evidence of increased activity in the thalamus, which can lead to increased anxiety and increased sensitivity to some body parts. So you can have “bodily” related OCDs, like hair pulling and skin picking.

  • Check more about Body Related OCD.

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Types of therapies work for Anxiety Disorders & OCD

It's important to note that these therapies can be combined and tailored to an individual's specific needs. What works best for one person may not work for another, so it's important to work with a mental health professional to determine the best course of treatment.

1. Cognitive Behavioral Therapy (CBT): CBT is a type of therapy that focuses on identifying and changing negative thought patterns and behaviors that contribute to anxiety. This is done by working with a therapist to identify specific negative thoughts and behaviors, and then challenging and replacing them with more positive, helpful ones. CBT is often short-term, and can be delivered in individual or group therapy settings.

2. Exposure Therapy: Exposure therapy is a type of therapy that involves gradually exposing individuals to the things that trigger their anxiety in a safe and controlled environment. This is done with the guidance of a therapist who helps the individual develop coping strategies to manage their anxiety. Over time, exposure therapy can help individuals desensitize to their triggers and reduce anxiety.

3. Mindfulness-Based Therapies: Mindfulness-based therapies, such as Mindfulness-Based Stress Reduction (MBSR) and Acceptance and Commitment Therapy (ACT), focus on cultivating present-moment awareness and acceptance of difficult thoughts and emotions. This is done by practicing mindfulness meditation, where the individual learns to observe their thoughts and emotions without judgment. Mindfulness-based therapies can help individuals develop greater emotional resilience and reduce anxiety.

4. Psychodynamic Therapy: Psychodynamic therapy explores the unconscious emotions and past experiences that may be contributing to anxiety. This is done by working with a therapist to explore patterns of behavior and thought that may be rooted in past experiences, and identifying the underlying emotional conflicts and motivations. Psychodynamic therapy can be longer-term than other forms of therapy and requires a high degree of trust and rapport between the individual and therapist.

5. Medication: Medications used to treat anxiety disorders include benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). These medications work by altering the balance of chemicals in the brain to reduce anxiety symptoms. Medication is often used in conjunction with therapy to provide short-term relief of symptoms, while the individual works on developing long-term coping strategies through therapy.

6. We provide therapy for people who are from Cleveland, Columbus, Dayton, Cincinnati, and any other parts of OH!

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References:

Stahl, S. M. (2021). Stahl's essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).