Anxiety and Obsessive Thoughts: A Case Study

Q: Anxiety and Obsessive Thoughts: A Case Study

Hello, user： Based on your description, your boyfriend is likely suffering from Obsessive-Compulsive Disorder (OCD). <br>This is a condition related to dysregulation in the brain's neurotransmitters. <br>With treatment using medications such as selective serotonin reuptake inhibi

I have a constant feeling that I've lost something important?

Hello Dr.
Chen, my boyfriend (who is currently in his second year of graduate studies in electrical engineering) expressed to me in mid-July that he is very afraid of losing important small items on his body.
When I asked him what important items he was afraid of losing, he said, "I just don't know what might fall off, and I'm very afraid that I might accidentally wash away something important while showering or washing my hands."
I traced back the timeline and found that he had started to frequently worry about forgetting something since March of this year, which would occupy his thoughts for one or two days (in reality, he had not forgotten anything, but despite my reassurances, he continued to dwell on it).
By the end of July, I noticed that he would scrub his body before showering and place the dirt and sand he scrubbed off into the basin, as he wanted to check again if it was just sand (which he would leave there for a while).
His sleep has worsened; he experiences light sleep and frequent interruptions.

In August, I suddenly noticed that every time he entered the house, he would wash his hands first, leaving the water running and carefully inspecting what was in it, repeating this about five times a day.
He would also wash his hands before going out and would avoid touching anything inside the house afterward because he was worried about "sticking" important items from the house to the outside.

I realized there was a mental health issue and he visited a psychiatrist three times.
However, due to the distance, I couldn't constantly urge him to follow up at the clinic, and he himself was very resistant to seeing a psychiatrist.
After taking medication twice, he did not complete the third round because he felt much better.
The doctors did not explain what illness he had; they prescribed Prozac and Dormicum (for a week).
After taking the medication, his symptoms did not improve.
After some time, I forced him to see a doctor again, who indicated that anxiety was a significant component.
He was prescribed Prozac and Ativan.

Since we meet about 1-2 times a month, in November he told me that his symptoms had improved significantly.
Indeed, he only washes his hands when entering or leaving the house and is willing to discard the sand, but his internal worries still persist; it seems that his anxiety has slightly lessened.
I continue to urge him to see a doctor, but he is unwilling, insisting that he is getting better and does not need it.

Although he has not had such symptoms in the past and seems to be improving now, I am concerned about whether this could be hereditary (there is no such history in his family) and if our future children might also be affected.
I worry that his low frustration tolerance could lead to more severe issues in the future.
He is aware that he is anxious but feels unable to control his thoughts.
He now expresses that he is slowly coming to terms with it, which is why his symptoms have alleviated.

If it is anxiety disorder, can it improve without medication? Is long-term medication necessary for anxiety disorders, similar to depression? Could he be experiencing anxiety combined with obsessive-compulsive disorder? Thank you for patiently reading this, and I appreciate your efforts.

Hui, 20~29 year old female. Ask Date: 2004/12/09

Dr. Chen Guangpeng reply Psychiatry

Hello, user: Based on your description, your boyfriend is likely suffering from Obsessive-Compulsive Disorder (OCD).
This is a condition related to dysregulation in the brain's neurotransmitters.
With treatment using medications such as selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, approximately 70% of patients experience improvement.
The outcomes are even better when combined with cognitive-behavioral therapy (CBT), although there is a high likelihood of chronicity.

Many patients, like your boyfriend, are reluctant to seek help, so there is limited research on the genetic probabilities associated with this disorder.
Even when studies exist, they may not be representative.
I can only share that I have treated a family where at least four out of five members had the same condition.

Does this response make you feel anxious? In fact, conditions like OCD are more about quality of life.
If the impact is significant, there will naturally be enough motivation (whether from themselves or others) to seek treatment.
Your boyfriend's treatment and disease course are expected—without adequate dosage and duration, symptoms will not improve.
Similarly, after discontinuing medication, symptoms may not necessarily worsen dramatically, but a relapse is likely.
Regarding genetic factors, it would be helpful to understand his family medical history.
If there is a family tendency, the likelihood of inheritance increases; if not, you can feel more reassured.
My recommendation is to visit the original healthcare provider or a larger hospital, or gather information online from relevant resources.
This will help your boyfriend better understand his condition, resolve his mental blocks, and encourage him to pursue treatment actively.
Best wishes to both of you.

Reply Date: 2004/12/09

More Info

It sounds like your boyfriend is experiencing significant anxiety and possibly obsessive-compulsive tendencies. From what you've described, his fears about losing important items and the compulsive behaviors surrounding washing and checking are indicative of anxiety disorders, particularly Obsessive-Compulsive Disorder (OCD). OCD is characterized by intrusive thoughts (obsessions) that lead to repetitive behaviors (compulsions) aimed at reducing the anxiety caused by those thoughts.

Understanding Anxiety and OCD
1. Anxiety Disorders: These are a group of mental health conditions that include generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and OCD. Individuals with anxiety disorders often experience excessive worry about various aspects of life, which can interfere with daily functioning.

2. Obsessive-Compulsive Disorder (OCD): This condition is marked by unwanted and intrusive thoughts (obsessions) that cause significant anxiety, leading to compulsive behaviors (compulsions) aimed at alleviating that anxiety. In your boyfriend's case, his fear of losing important items and the need to repeatedly wash his hands or check for cleanliness are classic signs of OCD.

Diagnosis and Treatment
Your boyfriend has seen a psychiatrist, which is a crucial step in addressing his symptoms. The medications prescribed, such as SSRIs (like Prozac) and benzodiazepines (like Ativan), are commonly used to treat anxiety disorders and OCD. SSRIs can help reduce the frequency and intensity of obsessive thoughts and compulsive behaviors over time. However, it's important to note that medication is often most effective when combined with cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP), which is a specific type of CBT for OCD.

Concerns About Heredity and Future Implications
Regarding your concerns about heredity, while there is some evidence suggesting that anxiety disorders can run in families, it is not guaranteed that children will inherit these conditions. Environmental factors, personal experiences, and coping mechanisms also play significant roles in the development of anxiety disorders.
Your boyfriend's current struggles may stem from a combination of genetic predisposition and environmental stressors. If he has not previously exhibited these symptoms, it could be that recent life stressors or changes have triggered his anxiety.

Coping and Management
1. Therapy: Encourage him to consider therapy, even if he feels better. Therapy can provide him with tools to manage his anxiety and prevent relapse.
2. Support: Your support is crucial. Encourage open communication about his feelings and fears without judgment.
3. Lifestyle Changes: Regular exercise, a healthy diet, and good sleep hygiene can also help manage anxiety symptoms.

4. Mindfulness and Relaxation Techniques: Practices such as mindfulness meditation, yoga, or deep-breathing exercises can help reduce anxiety levels.

Conclusion
While your boyfriend seems to be experiencing some improvement, it’s essential for him to continue monitoring his symptoms and seek professional help if they return or worsen. Anxiety disorders can be managed effectively with the right combination of therapy and medication, and many individuals lead fulfilling lives despite their conditions. Encourage him to remain proactive about his mental health, and reassure him that seeking help is a sign of strength, not weakness.
In summary, while anxiety and OCD can be challenging, they are treatable conditions. With appropriate care and support, your boyfriend can learn to manage his symptoms effectively.

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I'm sorry, but I can't assist with that.

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