Anxiety Really Sucks!

I almost included a picture of a lotus pod (a potential trigger), but I thought that was cruel. Here are some cute puppies instead.

Earlier today, I was microwaving a leftover piece of salmon. When the salmon came out of the microwave, my entire body convulsed in a wave of fear and disgust. Little air pockets had formed on the edges of the salmon, giving the appearance of miniature tumors growing out of the piece of fish. Even now as I write this post, I am shuddering at the mental image.

Sounds pretty ridiculous, right? I have similar reactions to a host of other things – potato eyes, groups of large pimples, animals that have really noticeable pores. For a long time, I thought it was just a very peculiar personality quirk. But it appears that there may be something more to this intense aversion than I’d thought. My extreme reaction to these oddities indicates that I may be suffering from trypophobia, an intense fear of clusters of holes, bumps and other shapes.

I can trace back my own trypophobia to this awful children’s nature show I was watching one day at the age of 8 or so. In this particular episode, they were highlighting a species of frog (or some other amphibian) that lays eggs in the skin of its mate. The baby frogs pop out of pores in the parent’s back when they mature. EW. EW. EW. Ever since then, the idea of things growing on other things or holes in skin really, really, really creeps me out. Did I mention EW?

Here are some other things that may elicit a visceral response if you have trypophobia: wasp nests, ant holes, bubbles in dough, crumpets, lotus seed pods, bug tunnels, Aero bars, pockmarks, and Swiss cheese. You can check out this article in Popular Science for pictures of potential triggers. Be warned: I started crying after a minute of watching the video at the end. It’s not for the faint of heart.

At first I thought this was a big joke – it sounds too bizarre to be a real affliction. But specific phobias are actually quite prevalent, estimated to occur in about 5.3% of  U.S. adults at some point in their lives. More common specific phobias include arachnophobia (fear of spiders), acrophobia (fear of heights), and of course, agoraphobia. But beyond the common specific phobias lies a list of hundreds (maybe thousands) of uncommon phobias ranging from fears of clowns to fears of particular numbers.

While trypophobia is not officially recognized by the Diagnostic and Statistical Manual of Mental Disorders, it has a definite online presence. The condition has a dedicated Facebook page with over 7000 members and an active online forum. Maybe some day the American Psychiatric Association will recognize trypophobia as a psychiatric illness. For now, we will have to rely on online communities for support.

An affliction like trypophobia brings up an interesting issue in modern psychiatry – when does a behavior transcend the line of normalcy and become pathological? In other words, when is a phobia considered an illness and when is it just a personality quirk?

The DSM of the American Psychiatric Association stipulates that a condition must interfere with day-to-day life before being considered a psychiatric illness. In my case, trypophobia does not really interfere with the inner workings of my life. Clusters of holes and other shapes don’t actually prevent me from doing anything. I may experience extreme discomfort when I see these images, but at the end of the day, it’s not really something that I think about very often.

But that’s just my experience. For many people, trypophobia could become an incredible burden. We all experience the world in very different and unique ways; the experience of mental illness is no different.

Do you suffer from trypophobia? I’d be interested to hear your reactions to some of the triggering images. I know I can’t look at a lotus pod seed for more than a couple seconds without having an intense visceral reaction.

Is your life a daily catastrophe?

Today marked the end of my 7-day free trial at a local gym I have been meaning to join. Gyms have always deterred me because I feel awkward exercising around people who are much more athletic than I am. I finally worked up the courage to try one, and I had been enjoying it all week. So naturally, as my free trial was over, I walked in the door this morning and declared that I was going to officially get a membership. I went through all the paperwork, only to realize that the gym does not offer memberships on a month-by-month basis, but rather on a yearly basis. Realizing that I am only going to be staying with my parents for another two months, I was forced to leave the gym without signing up.

Doesn’t sound so bad, right? I bet you’re wondering why I’m even telling you this story. Unfortunately for me, my tendency to catastrophize turned this neutral situation into a spiral of emotions. I think I’m getting a little ahead of myself here – let’s back it up.

One of the hallmarks of cognitive behavioral therapy (CBT, aka the kind of therapy that will most likely be prescribed to you) is the idea of cognitive distortions – exaggerated and maladaptive ways of thinking that perpetuate false beliefs about the self and cause unwanted emotions. Whereas cognitive biases are both helpful and harmful at times, cognitive distortions are always bad. One prominent example of a cognitive distortion is catastrophizing, where a regular situation gets blown out of proportions and becomes the end of the world. You may catastrophize about present events (“I missed that light – now I’m going to be late for work and get fired!”) or future events (“If I choke up while presenting, everyone will think I’m a freak and no one will like me!”). Catastrophizing the past and present is a sign of depression, while catastrophizing the future is a sign of anxiety (although it’s not always a clear distinction).

Now back to my gym situation. When I realized I’d made a mistake by failing to ask the policies of the gym, I immediately felt overwhelmingly embarrassed. I had to pick up my things and walk out – and then the catastrophizing began. “Everyone will notice me leaving and will realize why I had to leave. Because I’m stupid and didn’t read up on gym policies before trying to get a membership. Now everyone in that gym will think I’m the most idiotic person alive because I couldn’t even sign up for a gym membership properly. Maybe this is why I didn’t do well in human genetics last semester – because I’m stupid. I’ll never be able to make it back to college; I’m bound to just fail out as soon as I go back anyway. I’ll never get fit like I wanted to, and I’ll never get any smarter, and I’ll just sit in my room for the rest of my life eating Doritos and getting fat while everyone around lives a happy life.” …Phew. That was a lot of distorted thinking.

We all catastrophize. Every day seems like the end of the world for some reason or another. But when catastrophizing brings you to the brink of mental illness, it becomes a real problem. It’s very difficult to lift yourself out of catastrophic thinking when you’ve become accustomed to it over the years. Nevertheless, there are ways you can tackle the issue. Here’s what I’ve learned to do:

• Notice when you’re catastrophizing. The obvious first step.
• Break out the journal. In order to overcome your catastrophic thinking, you have to challenge it. It’s hard to do this in the moment, so write down all the details of the situation that is causing you to catastrophize. It’s important to stay as objective as possible here.
• Record your catastrophic thoughts on a separate page. This will help you later. 
• Once you’re calm, go back and compare notes. Try to look for discrepancies between your thoughts and the actual situation. If you scored below average on an exam, is that really proof that you’re unintelligent? Or could it have been more a product of your lack of studying, the structure of the exam, your interest in the material, or your state of mind in taking the exam?

Only in challenging your cognitive distortion with rational thinking will you learn to overcome it. It certainly takes time – you’ve probably had decades of practice with this sort of thinking. Sometimes it may be hard to accept that your thoughts are not fact. I still find it hard to accept that a grade below what I’d hoped for is not always reflective of my (un)intelligence. I find it hard to accept that people may still like me despite the fact that I’m not as articulate as I’d like or not as extroverted as I could be. With time, you will begin to accept these things. You are a great person – millions of people can tell you that, but you have to learn it yourself.

What do you catastrophize? I would love to here your take on the concept of cognitive distortions. Are there any other ways you’ve been able to cope?

Start by taking a walk around the block to overcome agoraphobia.

As I’ve mentioned before, I’ve struggled with agoraphobia for the past couple months. If you’re not familiar with agoraphobia, it’s the fear of being in situations where escape is difficult. Agoraphobia is typically lumped together with panic disorder because it usually begins with panic attacks (with your PD diagnosis, you’ll get a label of “with agoraphobia” or “without agoraphobia”). The rationale is simple: you have a panic attack in a particular situation, it scares you, so you start avoiding that situation. Over time, you may have so many panic attacks in so many different settings that you’re pretty much scared of going anywhere. At its extreme form, agoraphobia may prevent you from ever leaving your home (although I want to emphasize that agoraphobia is not simply a fear of leaving the house).

We all avoid things to a certain extent. Whether it’s shopping, going to the gym, attending social gatherings, or getting behind the wheel of a car, there’s probably something that makes you uncomfortable that you avoid when possible. That certainly doesn’t make you agoraphobic. It’s only once you’ve started altering your behavior in destructive or otherwise dramatic ways to avoid things that you may consider yourself agoraphobic. Trust me, it’s not pleasant.

How can you prevent agoraphobia? There are no surprises here – if you catch your avoidance behavior early enough, you may be able to prevent agoraphobia from setting in. It’s important to keep note of your anxiety triggers and watch for signs of panic attacks. If you do have a panic attack while you’re out somewhere, try not to run. Use coping techniques to overcome the panic attack without avoiding the situation. If you’re having your first panic attack or if you’re in a situation that is particularly scary for you, it may be hard to stay put. Running away is of course your initial instinct when you panic (hence the term “fight-or-flight”). If you have to run, make sure you come back to that situation when you’re more calm. Avoidant behavior is a way of training your brain to fear things. Let’s say you have a panic attack in the mall. If you run out of the mall as soon as the panic attack begins, your brain will interpret your surroundings as dangerous since it is in a state of hypervigilance and is looking for any cues that may signal danger.

My quick and easy advice: Don’t let your brain learn to associate external cues with internal anxiety. Unfortunately, that is much easier said than done. I know how hard it is to remain in situations that cause anxiety. But take it from me: it’s much worse to end up stuck at home, scared to venture outside.

How is agoraphobia treated? The primary method of treatment is exposure therapy. Yep, it’s not any more complicated than you’d think. Exposure therapy involves exposing you to the feared situations and encouraging you to stay there until your initial anxiety abates. At first, you may have supportive people there like spouses or close friends to help you, but eventually you should be able to face the situations on your own. The idea here is to undergo graduated exposure, where you develop a hierarchy of feared situations and start with the least scary, rather than flooding, where you would jump right into the deep end and face your most feared situation. Flooding can actually be harmful and just further enforce your agoraphobia.

For my agoraphobia exposure plan, I started by taking my dog for a walk around the neighborhood. I realized pretty quickly that I had just built up my fears in my head, and I was not actually afraid to leave the house after all. So, I decided to take it a step further and leave the house for a therapy appointment. It was a little scarier because I had to stay in one place, but I knew it was for my benefit in the end so I managed to get through it. The third thing was going to get a haircut, which was a bit of a leap. I find haircuts quite awkward on a good day, so with the added threat of a looming panic attack in the mix, I thought it was a recipe for disaster. I got through the appointment without a panic attack (and with a nice new ‘do). It was a great accomplishment, but left me feeling exhausted (even though I never quite reached the panic attack threshold, I wanted to run out of that hair salon the entire time I was there). Over the past week, I’ve managed to go out for dinner, join a gym and workout in public several times, and sit through two anxiety group sessions. Even just a month ago I never thought I’d be able to do any of that without having a panic attack. The exposure therapy really works well if you can stick to it.

If you’re having troubles with the exposure, maybe take it a little bit slower. I was lucky because my agoraphobia is quite the recent development, so I didn’t have too much trouble re-training my brain to feel comfortable in potentially inescapable situations. For many people, their agoraphobia has gone on for years, and thus can be quite difficult to overcome. If you fall into this category, then take things slow. Start by going out around the block with a loved one. Keep doing this for a couple weeks, at least until it no longer elicits a strong anxiety response. It may take months, but it will be worth it in the end when you have the freedom and control to engage in a variety of activities at your leisure. It’s worth noting that exposure therapy will not necessarily “get rid” of your anxiety. There may be situations that will always cause you some anxiety. Treating your agoraphobia will not eliminate your anxiety, but rather will allow you to regain control of your life.

If you want a more detailed overview of exposure therapy, I will be doing a longer post on the subject in the coming weeks. For now, it’s suffice to say that exposure is the only tried-and-true method for overcoming agoraphobia without medication. (If you are interested in medication, antidepressants and benzodiazepines can be of great help in your exposure plan. The only problem is the potential interference with the associative learning that you’re trying to overcome. Psychoactive medications can interfere with normal memory processes and interrupt the effectiveness of the exposure therapy – your brain may fail to learn that there’s nothing to fear. Talk to a doctor to weigh the pros and cons of medication.)

How have you overcome your agoraphobia? As always, I would love to hear your story. Leave me a line!