Anxiety: When Harmful Thoughts Cause Distress

My husband's anxiety issue is not about being victimized, but rather about being harmed. What should I do?

Hello, doctor.
I have read a lot about anxiety symptoms, and most of them seem to be related to excessive worry about being harmed.
However, my husband has always had thoughts about wanting to harm others, especially women.
Recently, this episode has become very severe, and he is experiencing intense anxiety and agitation due to the constant battle against these thoughts.
While working outside, he has lost a lot of weight due to a lack of appetite and has shaved his head.
His colleagues have expressed concern, but he is afraid that his harmful thoughts will lead him to hurt those who care about him, so he consistently rejects their concern and isolates himself.
He deeply despises himself for this and worries that he will never get better, feeling that life has no value.
Every day, he wakes up not knowing why he should continue living.

I would like to ask the doctor if this is also considered anxiety disorder.
The anxiety I have read about seems to focus on fears of excessive worry about being harmed or behaving strangely, but my husband is constantly worried about having harmful thoughts that compel him to hurt others, which prevents him from talking to anyone.
He repeatedly rejects others' concern and fears that people think he is very reclusive.
He doesn't know what to do and feels that he will suffer like this for the rest of his life.
He feels a deep sense of despair and believes that there is no solution to his painful existence.
The persistent harmful thoughts leave him feeling hopeless, and he has no confidence in himself.

In the past, when he consulted doctors, they told him, "Don't think too much," or "It's not that serious!" However, my husband insists that he is constantly thinking about harming others and even has inappropriate fantasies about any woman, which is clearly a frightening issue, yet the doctors seem to dismiss it, so he has not been on medication.
Currently, with my encouragement, he takes one dose of fluoxetine and one dose of alprazolam every night before bed.
Are these two medications appropriate for his condition? Thank you, doctor, for your assistance in answering this.

Qiu Jiu, 30~39 year old female. Ask Date: 2017/07/27

Dr. Zhang Fangrong reply Psychiatry

Dear Sir/Madam,
From your description, it is evident that your husband is experiencing discomfort and agitation, as the situation you outlined is quite serious and has been affecting his daily life and work.
The best course of action at this point is to maintain regular medical consultations with his physician and to use and adjust medications as advised by the doctor.
With consistent treatment, it is expected that your husband's condition should gradually improve.
I believe that medication therapy is a necessary option at this stage, and it is indeed the right approach to persuade your husband to adhere to his medication regimen.
In the future, you may also consider asking the physician for a referral to a psychologist for a comprehensive psychological evaluation.
Wishing you both mental and physical well-being.
Sincerely,
Dr.
Fang-Rong Chang
General Psychiatry

Reply Date: 2017/07/27

More Info

It sounds like your husband is experiencing significant distress due to intrusive thoughts that are causing him anxiety and fear of harming others. This situation is indeed concerning and can be classified under anxiety disorders, particularly Obsessive-Compulsive Disorder (OCD) or even a form of anxiety that involves intrusive thoughts of harming others, which can be very distressing for the individual experiencing them.

Intrusive thoughts are unwanted thoughts that can cause significant anxiety and distress. In your husband's case, the fear of acting on these thoughts, especially towards women, is understandably troubling for both him and you. It's important to recognize that having these thoughts does not mean he will act on them; many people with similar experiences are horrified by their thoughts and actively seek to avoid them. However, the distress they cause can lead to avoidance behaviors, such as isolating himself from others, which can exacerbate feelings of loneliness and despair.

The symptoms you describe—such as anxiety, irritability, loss of appetite, and feelings of worthlessness—are common in individuals dealing with severe anxiety and intrusive thoughts. It’s crucial for your husband to seek professional help from a mental health provider who specializes in anxiety disorders or OCD. A qualified therapist can provide cognitive-behavioral therapy (CBT), which has been shown to be effective in treating OCD and anxiety disorders. This type of therapy can help him learn to manage his thoughts and reduce the anxiety associated with them.

Regarding the medications your husband is currently taking, it’s essential to consult with a psychiatrist or a healthcare provider about their appropriateness for his specific situation. Prozac (fluoxetine), which is a selective serotonin reuptake inhibitor (SSRI), is often prescribed for OCD and anxiety disorders, as it can help reduce the frequency and intensity of intrusive thoughts. Xanax (alprazolam), on the other hand, is a benzodiazepine that is typically used for short-term relief of anxiety symptoms. While it can help with acute anxiety, it is not a long-term solution and can lead to dependency if used regularly.

It’s also important to address the stigma and fear surrounding mental health treatment. Your husband may have encountered dismissive attitudes from previous healthcare providers, which can be discouraging. Encourage him to seek a second opinion or find a mental health professional who is empathetic and understands the seriousness of his condition.
In addition to therapy and medication, consider exploring support groups for individuals dealing with similar issues. Connecting with others who understand what he’s going through can provide a sense of community and reduce feelings of isolation.

Lastly, remind your husband that he is not alone in this struggle, and with the right support and treatment, it is possible to manage these thoughts and improve his quality of life. Encourage open communication between the two of you, as discussing his feelings and fears can be a vital part of the healing process.

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