0CD Perfectionism

What’s so wrong with striving to do your very best? Without high expectations, what would motivate you to accomplish your goals and aspirations?

There is nothing wrong with working hard and and setting certain standards for yourself. However, if you live with anxiety because you are terrified you may make a mistake or a wrong decision, you may be suffering from OCD perfectionism.

OCD perfectionism should not be confused with obsessive-compulsive personality disorder, or OCPD. The latter is not an anxiety disorder; it is a personality trait which initiates behaviors that demand rigidity and inflexibility. Conversely, OCD perfectionism is a symptom of an anxiety disorder, and may include a constellation of behaviors and symptoms.

The individual with this diagnosis is often in extreme distress due to their unrealistic expectations, which leads to procrastination, indecisiveness, self-reproach, anxiety and depression. OCD perfectionism has far-reaching effects, and contributes to skin-picking (dermatillamania), eating disorders, social anxiety disorder, dirt contamination, phobias, and body dysmorphic disorder, just to name a few.

When an individual suffers from OCD perfectionism, nearly every action is viewed from the perspective that there is a right way and a wrong way: there is no gray area. This simplistic view can cause a person to procrastinate endlessly for fear of making a wrong decision. Relationships, jobs, or anything that requires some small degree of risk-taking can therefore be crippling.

It can afflict an individual with regard to their own need to be perfect; and it may also affect their need for others to comply with their perfectionistic standards. They can be so controlling and demanding that their relationships buckle under the stress, and the resultant rifts are sometimes irreparable. Imagine living with someone who insists you do everything in a particular way or he or she becomes angry and critical. The OCD perfectionist often does not have the insight to recognize just how controlling their behavior can be — and how precarious their careers, academic life and relationships are becoming as a result.

The treatment for OCD perfectionism is to teach the individual how to tolerate the discomfort of relinquishing the need to be perfect. For example, I have encouraged clients to leave home with their socks mismatched, without makeup, and dressed in clothing that is not coordinated well. I may suggest that they limit their time at any particular store while shopping, especially if they have had a pattern of spending excessive amounts of time struggling with choices about their purchases.

OCD perfectionism is pervasive, and usually worsens over time unless it is treated. The prognosis, like most anxiety disorders, is excellent with the proper treatment.

Dementia, Anxiety and caregiving

An entry on dementia may seem a bit out of place on a blog that addresses anxiety and chronic illness. However, it is relevant for several reasons.

First and foremost, I have several clients whose reason for seeking treatment was that they were experiencing feelings of acute anxiety that were not precipitated by any triggers consistent with an anxiety disorder. As it turned out, these people had a parent or spouse who had been diagnosed with some form of dementia. In many cases, they were swamped with anxious feelings shortly after learning about the diagnosis — and as the symptoms of their loved one’s dementia became more obviously problematic, so too did their own anxiety.

There are many different types of dementia, and no test can determine with 100% accuracy the type from which one may suffer. Unlike other physical illnesses, the diagnosis can be frustratingly vague, and it is difficult to know exactly what to expect in terms of symptoms and the course the disease will take. To complicate matters, if the diagnosis is Alzheimer’s disease, symptoms can vary widely from person to person. All of this ambiguity and uncertainty can initiate feelings of confusion, fear, depression and loss. Moreover, if you suffer from health anxiety, or generalized anxiety disorder, it can unleash a flood of fear that you may develop dementia at some point in the future. You may experience simultaneous feelings of worry about your parent and your own fears of a pending ominous future.

Needless to say, anxiety is not the only challenge one encounters in dealing with a parent or spouse suffering from dementia. In my practice, I have counseled many families who are learning to navigate the process of accepting the limitations of a family member with a chronic illness. There are specific differences to caregiving someone with dementia, and it requires even more care and attention.

The majority of incidents of elder abuse occurs not within the confines of a nursing facility but in the home, where care is being given by a family member. This is because the stress of taking care of an individual who is significantly cognitively impaired can be extremely frustrating at best, and often simply overwhelming. The demands placed upon the primary caregiver are often relentless and unrealistic. When the individual with dementia is a parent, caregiving often falls on the children, particularly if the parent’s spouse is deceased or ill. It’s safe to say there is a good reason for the term “caregiver burnout.”

One would expect that such demands and responsibilities would be shared equally if the parent in question has more than one child, particularly if they all live in the same locale. Unfortunately, this is rarely the case. All too often, one of the children becomes more involved with the parent’s care, and the other siblings permit that burden to fall upon their brother or sister. They are often quite happy to allow their sibling to accept the majority of responsibilities; and resentments, unsurprisingly, can follow.

Before you find yourself releasing your frustration on your parent or partner, it is important that you seek resources that can support you. You need to be able to maintain a proper balance of giving care and taking care of yourself. If you are in a position where you find that your anxiety is building, locate a therapist and get treatment. If you are in the position of being the primary caregiver and have siblings that cannot (or will not) help you, utilizing the assistance of a therapist competent in caregiver mediation can be beneficial.

Overcoming Health Anxiety: (formally called Hypochondriais)

For Most people, a recently-appeared skin blemish or a headache is nothing to be alarmed about. But if you suffer from health anxiety, formally known as “hypochondriasis,” symptoms such as these could easily be interpreted as a life-threatening disease. You may visit your doctor excessively, or avoid going to the doctor altogether for fear that you will be diagnosed with something terrible. If you do see your physician, and he or she runs some tests, you are likely to assume the worst — and the waiting period can be agonizing.

Health anxiety can be a central feature of many different diagnoses, including depression, somatoform disorder, adjustment disorder and others. It can also be a central feature of certain anxiety disorders, such as generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), and panic disorder. Individuals suffering from GAD are most likely fear malignancies, while individuals with OCD most commonly worry about infectious diseases. Panic disorder sufferers often worry that they are going to have a heart attack, and/or fear a catastrophic reaction to a medication resulting in “medication phobia.”

Health anxiety is influenced by a number of other factors as well, such as the media reporting — in an often sensationalized manner — the risk factors for various diseases.  In such reportage, the risk factor of “stress” is invariably over-emphasized, which can create an even worse scenario: stressing about the effects of stress on your body! Television dramas such as Grey’s Anatomy or House depict individuals with mysterious (and often fatal) diagnoses. The Internet, of course, is rife with information that is frequently unreliable, and suggestible individuals can spend hours researching just one symptom. These cyberchondriacas are on a desperate search for some reassurance, but more often than not find their anxiety is only exacerbated by the ambiguity of their symptoms.

Two other contributing factors  are age and life events. Generally speaking, the older you are, the more vulnerable you feel to developing illness. You may have friends or relatives around your age that have succumbed to a major illness, or died. Health anxiety is, at its very core, a fear of dying. The reality that you cannot control what is imminent forces you to confront your own mortality. And the older you get, the worse your health anxiety will be.

There is effective treatment for health anxiety. However, the treatment of choice for all anxiety involves confronting your fears. Avoiding thinking about it, or trying to stop the thoughts, is not effective. It may help temporarily, but eventually your anxiety will return, because you can’t help but be aware that sickness and death are fundamentally inevitable at some point. In my practice of specializing in anxiety and chronic illness, I have observed that those clients who already have a serious illness usually do not fear falling ill; they’ve already adapted to it and, for the most part, have developed strategies to live within its limitations. Those clients who have had the fortune of being healthy are more likely to fear being diagnosed with a disease. They have not had the opportunity to learn that there are choices and resources available with many illnesses. It is no surprise, then, that the treatment of choice for health anxiety is a combination of cognitive therapy and imaginal exposure therapy. As threatening as these therapies may sound, they are time-limited, and initiate recovery.