Anxiety and obsessivecompulsive disorder

The challenge is when one deviates into a state of excessive anxiety and escalates to a point when it becomes debilitating.

Apr 16, 2022

                                       Heart, Mind  and Soul Fr Philip Chua

I am particularly fascinated by this quote from the renowned Lebanese author, Kahlil Gibran: “Our anxiety does not come from thinking about the future, but from wanting to control it”. It is a simple yet meaningful way of explaining the origination on anxiety.

But what actually is “anxiety”? Anxiety is a mental reaction which leads to a physical reaction when one perceives that one is in danger – more commonly known as the “fight or flight” response in humans. As preposterous as it may sound, anxiety is actually a good response as it draws focus to our challenges and shields us from dangers – the very instincts that have led to the survival and, ultimately, the prevalence of the human race.

The challenge is when one deviates into a state of excessive anxiety and escalates to a point when it becomes debilitating. Excessive anxiety may manifest itself in many forms, either physically, physiologically or mentally, or a combination of the three. Commonly observed examples include sweating, trembling, nervousness, restlessness, palpitations, and insomnia.

Generally, anxiety disorders can be categorised into three levels of severity. The mildest level is called “Generalised Anxiety”, where an individual is having an excessive amount of anxiety or worry in certain areas of his or her life, such as, job responsibilities, finances, health and minor concerns over completing housework or what people are thinking about them.

A notch higher in terms of severity are those categorised as “Phobias”, which is a very intense form of fear, skewing to a level deemed irrational, towards a specific subject. Examples include “acrophobia” (fear of heights), “agoraphobia” (fear of crowded public places), “claustrophobia” (fear of enclosed spaces” and “thanatophobia” (fear of death).

And finally, at the end of spectrum is an extreme form of anxiety called “panic”, where an individual is paralysed with a sudden feeling of terror despite the absence any real threat or danger. The individual may have a sense of losing control, often accompanied by physical symptoms such as rapid heartbeat, difficulty in breathing and dizziness — hence, the term “panic attacks”.

In addressing excessive anxieties, the primary goal of psychologists, therapists and counsellors is to help the individual reach a state of “normalisation”. And the first crucial step on this path is to understand the cycle of anxiety. Anxiety usually starts when an anxiety-producing situation causes discomfort resulting in worry, a racing of heart, feeling of being overwhelmed, fear and sweating. These uncomfortable feelings in return cause an individual to start avoiding the anxiety-producing situations which give rise to procrastination, turning to substance for relief and avoidance. And by doing all these, one can experience an immediate sense of relief, albeit temporarily. Therefore, it develops into a habit which the brain now learns – that when the anxiety-producing situation is avoided, the symptoms dissipate. As a result, the symptoms of anxiety will be worse the next time, and avoidance becomes more likely. It is like an endless negative spiral. So, what practitioners would focus on, as part of therapy, is to break this vicious pattern by reversing the cycle. This would warrant the individual confronting the feared situations without being aided, often resulting in a short-term increase in anxiety level, then a gradual decrease over time, in physical symptoms. The ultimate goal is to reinstate control to the individual through the use of coping mechanisms and skills so that there is greater confidence in one’s ability to control one’s responses.

Let’s shift our focus now to obsessive-compulsive disorders or, more commonly referred to by its acronym, OCD. The terminology has crept into our daily lexicon to be synonymous with one’s strong inclination to be neat, orderly and clean. Whilst such tendency exists, an individual only has OCD if the symptoms cause disruption to one’s daily life and mental anguish. Needless to say, the impact can be profound and often, incapacitating.

OCD is a disorder where an individual has recurring, unwanted thoughts, ideas, sensations and obsessions which result in them feeling the overwhelming need to do something repetitively. Such repetitive behaviours include hand washing, checking on things or cleaning. In a nutshell, the general tendency is towards excessive orderliness, perfectionism and an acute level of attention to detail.

OCD comes in many forms, but most cases fall into at least one of four general categories:

1. Checking, such as locks, alarm systems, ovens, or light switches, or thinking you have a medical condition like pregnancy or schizophrenia;

2. Contamination, a fear of things that might be dirty or a compulsion to clean;

3. Symmetry and ordering, the need to have things lined up in a certain way; and

4. Ruminations and intrusive thoughts, an obsession with a line of thought where some of these thoughts might be violent or disturbing.

Generally, individuals who have OCD know that their thoughts and habits do not make sense. They do not engage in them because they draw enjoyment from them but simply because they cannot quit the behaviour. OCD treatment pathways can be difficult and require significant courage and determination.

Treatment options include medicine or therapy, or a combination of both. The most effective treatment is a type of Cognitive Behavioural Therapy called “Exposure and Response Prevention”, often regarded as the gold standard in OCD treatment. Exposure and Response Prevention is typically done by a licensed mental health professional in an outpatient setting. Relaxation techniques such as yoga, meditation and massage are also prescribed to help alleviate stressful OCD symptoms.

(Fr Philip Chua is a registered and licensed Counsellor and Clinical Supervisor under Lembaga Kaunselor Malaysia. He is also the Ecclesiastical Assistant for the Archdiocesan Mental Health Ministry. If you have any queries or would like to seek counselling, write in to: lifejourney@ or