Anxious Obsessions
Obsessions are a common part of our
lives. They refer to periods when we have sets of ideas that keep circulating
around and around in our minds. They can be set up by interests, fascinations,
hobbies and enthusiasm. Collectors, football fans, and people who are dedicated
to a cause would all quite happily describe themselves as "obsessed". But
obsessions can also be set up by the strong emotions of anger, jealousy, grief,
depression and anxiety, and addictive behaviours such as eating disorders, and
substance abuse. In these cases the obsessions are far from "fun".
In
anxious obsessions, there are repetitive thoughts and images that are negative
and highlight some sense of danger. Sufferers are likely to say the thoughts and
accompanying feelings are powerful and difficult to control, and that they are
"plagued" by the thoughts. "I can't get it out of my mind" etc.
A
common anxious obsession, which can be part of agoraphobia, is what follows on
from having a strong spontaneous panic attack. Because the panic attack is
frequently accompanied by highly alarming speculations about death, severe
illness and losing control, sufferers easily see panic attacks as terrible
events and anxiously obsess about their possible return. Sufferers recurrent
thoughts may be about places where panic attacks may occur, whether body
sensations (eg heart palpitations) might "bring on" a panic attack, whether help
would be available, whether it would be seen by other's, whether hospitals might
be close by etc.
Another common variant (often following panic attacks
as well) are obsessions about one's physical health. Body sensations are closely
monitored and the repetitive thoughts are about possible signs of heart attacks,
cancers and other deadly conditions. Equally common, is the anxious obsession
about one's mental health. So one's own thinking process is closely scrutinized,
and any extreme thoughts are obsessed over as signs of "madness" or
schizophrenia.
Seen in this way, anxious obsessions are simply
distressing long drawn out and repetitive versions of typical anxious thoughts.
But it is the seemingly relentless aspect that gives the experience a
particularly painful dimension. The relentlessnesss easily gives a sense of it
being very difficult to control.
Anxious thoughts can convert to
anxious obsessions when the content of the thought is particularly personally
significant for the sufferer. Significance is often "What I really dread
happening" . The thoughts can be "congruent" (some plausibility about the
thoughts correctly predicting future bad events) or "incongruent" (far from what
the person would normally be aware of thinking).
A typically painful
"congruent" anxious obsession would be a loved one dying, ourselves dying and
leaving loved ones to fend for themselves, a relationship failing with a life of
loneliness beyond.
Equally painful is when the "thought" seems very
far from the person's own moral code, such as a staunch Christian having anxious
obsessions about the possibility of uttering blasphemous thoughts, or the
happily married person having anxious obsessions about leaving their spouse. In
the latter cases the person becomes distressed about the seemingly "unnatural"
presence of the preoccupation ("How could I be thinking that"??? Or " If I think
that, it means it may happen"). These "incongruent" ruminations often seem to
represent being out of control, mad, possessed or immoral.
Anxious
obsessions can occur in all anxiety states and all anxiety disorders. It is only
when it is connected with strong "rituals" or "compulsions" that are attempts to
"appease" or "neutralise" the obsession, that it becomes obsessive-compulsive
disorder (OCD). For example when the obsessions are about avoiding
contamination, and the rituals are frequent washing.
One of the best
self-help manuals on dealing with anxious obsessions (and also OCD) is by Foa,
an American psychologist, who has run clinics in this area for over 20 years. I
have used her work and strategies as a vital basis for my work with people
suffering anxious obsessions.
Essentially, the task is to learn to
ACCEPT the existence of the obsession, without accepting it's specific content,
all without fighting the actual obsession. Instead, the focus is on discovering
that obsessions can be postponed, time limited, faced, and altered. This sense
of control helps build confidence, which then weakens the anxiety component, and
as this happens, the importance of the obsession also weakens.
Joe Bolza was formally a clinical psychologist who specialised in anxiety disorders.