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Three Treatment Issues when you have OCD and Social Anxiety

Thursday, July 10, 2014

Janine is a 38-year-old married woman with two young children. She obsesses continuously about whether her house is neat and clean enough. She frequently stays up until three in the morning scrubbing and straightening. In addition, Janine is socially anxious and has few friends. She worries about what other people think of her and is terribly afraid of rejection. Some of her neighbors get together with their children to play in a nearby park or each other’s homes, but Janine never joins them.
You may easily recognize that Janine has obsessive-compulsive disorder* (OCD). What you may not recognize is that she also has social anxiety disorder. Janine is not alone; researchers estimate that 24% of individuals diagnosed with OCD receive an additional diagnosis of social anxiety disorder (1). In fact, this study found that social anxiety disorder is the most common additional anxiety disorder diagnosis made for those individuals with OCD.
Having both of these anxiety disorders together can make your recovery more difficult. In this article, we will describe social anxiety disorder, explain how it can complicate treatment, and call your attention to three key issues in dealing with the combination of OCD and social anxiety…
Social anxiety disorder is characterized by a persistent fear of criticism or negative evaluation from others. It is essentially a fear of disapproval…
A mental health professional who specializes with anxiety disorders should be able to help you assess whether or not you have social anxiety disorder in addition to OCD…
One way to do this is to trace the path of your irrational thoughts. If the path leads to a fear of rejection, of social isolation, of judgment by others, or of ostracism that is not based in the reality of the situation, then some degree of social evaluative anxiety is present. Depending on the extent that this anxiety influences your behavior, it may be social anxiety disorder.
Tracing the path of the irrational thoughts refers to a process in which you ask yourself, or a therapist asks you, "What would happen then?" in response to the report of fear. For example, if an individual with OCD states, "I am afraid of being contaminated," the interviewer then asks, "What would happen then?"
You may wonder why diagnosing and addressing social anxiety is important to your treatment. Why can’t the treatment of OCD and social anxiety be separate processes? In our experience, social anxiety appears to interact with OCD in a manner that necessitates attention to both disorders simultaneously.
One way that this interaction occurs is that obsessions and compulsions may protect the individual from more threatening social fears. As unpleasant and frustrating as the obsessions and compulsions may be, having to face a high anxiety-producing social situation may be even worse.
For example, a woman with these two disorders may be invited to attend a social function. Even though she may want to attend, she is very fearful of the situation and the potential for rejection. Her obsessions about the fear of harming someone cause her to avoid the situation, and thus, protect her from experiencing the social anxiety.
You may wonder if OCD causes the social fears and isolation because of the bizarreness of the behavior and the concern about what others may think. Perhaps if the OCD is treated, the social fears and isolation will disappear. While this may be the case in some situations, research shows that social anxiety disorder tends to develop, on average, at an earlier age than OCD. Additionally, most of the people we have treated report that their social fears occurred prior to the development of OCD. This corroborates our opinion that the obsessions and compulsions may develop in response to social evaluative anxiety.
It appears that the most severe cases of OCD are in combination with social anxiety disorder. We have observed that the severity of the OCD appears to increase with the degree of perfectionism. For those with the combination of these two disorders, the perfectionism tends to be overvalued. In other words, the individual accepts the perfectionistic beliefs as normal and rational. For example, as described above, the woman with social anxiety disorder may believe that she truly will be rejected by others if she isn’t perfect…

If you think you may have social anxiety disorder in addition to OCD, be sure and bring this issue up with your mental health professional. There’s every reason to believe that with careful attention to these treatment issues outlined that you can not only recover from your OCD, but from your social fears, as well.

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