Most people can relate to the feelings of anxiety. Your muscles tense, butterflies invade your stomach, and the rapid beating of your heart tells you that you’re not calm. And that’s totally normal. Where would we be if seriously dangerous situations like dark alleys at night didn’t give us the heebie-jeebies? And would we take important tasks very seriously if we didn’t get nervous in the spotlight, like when giving a presentation at work?
But there are times when our anxiety gets ahead of us and gets in the way of our everyday functioning. It can mess up our health, relationships, work, and fun activities. It’s not hard to imagine the pain of being plagued by constant worries or feeling so shy as to have trouble with dating. But sometimes, anxiety and anxiety-related processes can show up in more unusual ways, even ways that don’t seem at first to have anything to do with feelings.
The Diagnostic and Statistics Manual, 5th Edition is the American Psychiatric Association’s official list of psychological disorders. It’s a huge bible detailing all disorders and their categorizations. It takes experts years to update it in response to ongoing scientific findings.
The Anxiety Disorders section got a big makeover in the last update, which came out in 2013. It’s now split into a few different sections, including Trauma and Stress-Related Disorders and Obsessive-Compulsive Disorders. A few less common disorders got shuffled around, and some got new names, but experts still agree that the line between categories is blurry at best. Overlapping and related to some of the most common anxiety disorders, such as generalized anxiety disorder and social anxiety disorder, are some that aren’t so familiar to the general public.
Let’s talk about three little-known disorders related to anxiety. They’re rare, but for those who have them, they’re very real and disruptive.
If you’re a fan of The Big Bang Theory, you’ll already have some idea about selective mutism. Raj, the beloved astrophysicist at CalTech, speaks perfectly fine… except when it comes to talking to women. This character represents one of the rare adults with selective mutism, an anxiety-related disorder where someone consistently fails to speak in certain situations despite being able to speak in others.
This disorder is usually found in childhood, often starting between the ages of 2 and 5 when children go to daycare or preschool for the first time and don’t seem to be able to talk outside of their home. It’s a pretty rare disorder, occurring in less than 1 percent of children. Children usually grow out of it, though adults who used to have selective mutism are more likely to still have an anxiety disorder after they grow up.
How selective mutism is treated
So, Raj from The Big Bang Theory represents a tiny percentage of adults with any symptoms of selective mutism. Eventually, by the end of Season 6, he and his friend Penny accidentally discover that he’s gotten over it after a tough breakup. Good for him!
But usually, heartbreak is not the best course of action for selective mutism. The treatment with the strongest scientific support is Cognitive Behavioral Therapy—a structured, hands-on, short-term treatment that aims to change the person’s behaviors and thought patterns. For kids with selective mutism, a therapist would help them to work up a ladder from their easiest to hardest speaking situations by giving lots of encouragement and praise.
Michael Jackson has a complicated story and a controversial legacy. No matter your opinion of him, you may not know that some experts believe he may have had symptoms of body dysmorphic disorder (BDD). This is a psychological disorder where someone is very preoccupied with an aspect of their appearance that they believe is flawed, even though others don’t give it a second thought.
Someone suffering from BDD spends a lot of time and effort fixated on the perceived appearance flaw, trying to change it, covering it up, or getting others’ reassurance about it. This can cause problems for people because they’re spending hours altering their appearance. They may avoid socializing or let their anxiety about their perceived deformity get in the way of their relationships.
Sometimes, a person with body dysmorphic disorder gets plastic surgery to fix the perceived deformity. In fact, 7 to 15 percent of people who get cosmetic surgery have BDD. Unfortunately, surgery doesn’t solve the problem permanently—it only provides temporary relief before some new flaw and new preoccupation worms its way into the person’s mind and they feel compelled to do even more surgery to “fix” the new problem.
Michael Jackson seemed to have engaged in a large number of surgeries that drastically changed his appearance, and there did not seem to be a stopping point, which is why some believe he was dealing with undiagnosed BDD.
How body dysmorphic disorder is treated
Changing the person’s appearance is not the answer. After all, by definition, the supposed flaw is greatly exaggerated in the sufferer’s mind compared to how other people view it. Both medications and psychotherapy can help by relieving the root of the anxiety that drives the vicious loop of anxiety and preoccupation. The goal is to break the cycle of intense focus on the “problem” area that drives up the anxiety, which only gets reinforced by the relief that constant appearance-checking, seeking reassurance, and plastic surgery bring.
Trichotillomania is not only a difficult word to say, but it also represents a mental health disorder that is often hard to recognize. It is a disorder where a person has overwhelming urges to pull hair from their own body, usually from the scalp, eyebrows, or eyelashes.
Those who experience trichotillomania say there’s escalating tension before pulling, or when they try to resist pulling. They feel a big relief or even a sense of pleasure when they do pull hair out. Some simply throw the hair away, while some play with or even ingest the hair as part of the pulling ritual. These symptoms can cause problems for people if the hair-pulling results in noticeable hair loss, if it consumes a lot of time, or if it causes embarrassment that gets in the way of their normal life.
You may be surprised to hear that there are famous and attractive people who have trichotillomania. Olivia Munn, Colin Farrell, and Justin Timberlake have all talked publicly about having this disorder. In the general population, 1 to 3 percent of people have it, and it occurs most often in women. It tends to start in the early teens but can continue into adulthood for many years.
Why are some people at risk for developing trichotillomania? As with many psychological disorders, the answer isn’t straightforward. We do know that people with a family history of trichotillomania are more likely to have it themselves, and they’re also more likely than the average person to have other anxiety disorders. Experts believe that the pulling of the hair itself may be a way that people cope with stress and negative emotions like loneliness, fatigue, stress, and frustration. The problem is that the relief they feel from pulling makes them do it more, but also creates shame and guilt, leading to a cruel cycle.
How is trichotillomania treated?
Habit reversal therapy, when coupled with medication, seems to be the most promising treatment to break the cycle. Habit reversal therapy involves weekly psychotherapy sessions where people learn skills, including self-monitoring, emotion awareness, and stimulus control to help them create an environment to make themselves less able to pull, such as wearing gloves.
Because trichotillomania isn’t really about hair, just like body dysmorphic disorder isn’t really about someone’s nose and selective mutism isn’t really about language, it’s important to address the underlying issues that keep the engine of the disorder turning. Negative emotions, and most importantly, difficulty recognizing or coping with these feelings, are the real fuel for this engine. In the cases of these little-known anxiety-related disorders, this fuel not only activates the body’s natural anxiety but also takes away our confidence in the ability to sit with anxiety and survive negative emotions. Once we learn to trust ourselves again, we can reclaim our power.
A version of this piece originally appeared on Quick and Dirty Tips.
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