The Kinds Of Anxieties People Develop And Often Ignore To The Point Where Their Family Life Comes Under Threat
This is Ali Madeeh’s third article in our series on Mental Health. Ali discusses the two types of anxiety related illness in this article. His first article for Naya Daur on anxiety can be read here.
This evening, in my clinic, I will be seeing a young man who left a well paying job in the UAE and came back to Pakistan because he was convinced he had developed a deadly illness. The symptom started innocuously enough. He was driving his car at night when he had an accident.
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No one was injured but following that incident, this young man developed a fear of being alone and some difficulty sleeping. Later that evolved into some minor difficulty swallowing after which he became convinced that he had throat cancer. He also developed muscular twitches and jerks (a common symptom of anxiety) which led him to believe that he had some kind of deadly neurological illness.
He went on the internet and has, apparently, convinced himself that he has a debilitating neurological illness which is progressing and will result in his paralysis and death.
All of this has been conveyed to me by his family members since I have not seen him yet but it all sounds very familiar and illustrates features of two types of anxiety related illness.
Post-Traumatic Stress Disorder
Anxiety which develops after a traumatic incident (sexual assault, road side accident, being the victim of a violent crime or terrorist incident etc) generally follows a predictable pattern. The person develops a general sense of apprehension and fear along with ‘hyperarousal’.
Simply put, they become very jumpy. A loud noise or even a tap on the shoulder can cause them to startle. They often have trouble sleeping and when they do sleep, they complain of frightening nightmares often centered around the incident or a similar situation. During the day they can often experience ‘flashbacks’ which are essentially waking nightmares.
The person re-experiences the traumatic incident over and over during the day even though nothing is happening around them. They avoid reminders of the event (e.g. the victim of a roadside accident may become mortally afraid of driving or even getting in a car; a sexual assault victim may develop an intense fear or avoidance of normal sexual relations) and may go to great lengths to try and avoid re-experiencing the event. In addition, they may develop feelings of being detached from the outside world or even from themselves and may say that they feel as if they will die soon, that they have no future.
This is the illness which mental health professionals call ‘Post-Traumatic Stress Disorder’ and it can be both persistent and disabling.
Another common condition that I often treat is called Obsessive-Compulsive Disorder or ‘OCD’ for short. Like the young man described above, this illness manifests as both recurrent, intrusive, repetitive thoughts which are hard to resist (‘Obsessions’) as well as behaviors which often occur in response to those thoughts (‘Compulsions’).
In the case described above, the young man’s intense preoccupation with having some kind of deadly illness (despite medical evidence to the contrary) is typical. Obsessions related to cleanliness and contamination are also very common.
I once had a manager at a car company come to see me in despair because his wife was threatening to leave him. He had bought and sold two cars in the last two months (losing considerable money in the process) because as soon as he brought the new car home, he would feel as if it had a stain or urine or feces on it. He would scrub and wash it several times a day but the thoughts still tortured him. He couldn’t get in the car because he felt it was dirty.
Daily, without fail, when he got home, he would take off the clothes he had worn at work and put them in the laundry to be dry-cleaned. Then he would get in the shower and scrub himself from head to toe sometimes for 2-3 hours (he had a similar ritual in the morning).
After he got out of the shower, he would clean his cell phone with alcohol wipes to ‘decontaminate’ it and he had, in the past, washed his cell phone with shampoo more than once (needless to say, he had to replace his cell phone repeatedly). He couldn’t lie in his bed unless the bed sheets were changed daily and his slippers and shoes also had to be washed every day. His wife finally told him to either get some medical help or she was going to take the children and leave.
The writer is a psychiatrist practicing in Lahore. He taught and practiced Psychiatry in the United States for 16 years. He tweets @Ali_Madeeh