4 Things That Masquerade as Anxiety

Anxiety is likely the most common difficulty reported by clients I meet. Whether it is anxiety due to life circumstances or a health condition, the on-edge, in-your-face experience can be highly upsetting, and understandably creates a strong desire to escape. Yet, many anxiety disorders are only one of many causes of anxiety, and finding the right diagnosis can be key to creating a plan to tackle it. What follows are four common conditions that often show up with anxiety but are not anxiety disorders.

1. Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) has a way of creating intense anxiety around a specific theme, such as fear of acting immorally or of illness. When someone is in the midst of an OCD spiral, it is difficult to focus on much else, and many participate in rituals such as asking questions or looking up information repeatedly as ways to seek reassurance. These and other rituals create the "compulsion" part of OCD. Still, it is possible to have OCD without having any compulsions at all.

A lack of knowledge on OCD is not just common among the general public, but clinical populations as well. A study that provided primary care physicians with one of eight vignettes describing a patient with OCD found that physicians were slightly more than 50% likely to misdiagnose the vignette, leading to inappropriate and potentially harmful treatment recommendations (Glazier et al., 2015). Due to a lack of awareness of the rainbow of ways that OCD can appear, many with OCD are misdiagnosed with several conditions, including generalized anxiety disorder.

Still, OCD is treatable. A variety of psychotherapies have shown efficacious for OCD like exposure ritual prevention therapy, acceptance commitment therapy, and, most recently, inference-based cognitive behavioral therapy. With the appropriate treatment, a person living with OCD can learn to understand their obsessions and the painful uncertainty created. Medication and alternative treatments, such as Transcranial Magnetic Stimulation, are sometimes also used in the treatment of OCD.

2. Post-Traumatic Stress Disorder

Among the most severe cases of anxiety I have encountered, PTSD has been a common diagnosis. In PTSD, there is sometimes an ever-present sense of being in danger, which facilitates hypervigilance, making it difficult to relax. While the anxiety is often easily identified, the trauma generating the anxiety might not be so easily recognized.

While PTSD is often characterized in the eyes of the public and many clinicians by flashbacks and nightmares, this is only a small dimension of how PTSD symptoms can show up. For many, re-experiencing symptoms of PTSD does not involve explicit memories as much as implicit bodily and emotional sensations such as fear. Avoidance symptoms that can make it difficult to talk about the traumatic experience can also delay diagnosis.

Through psychotherapy, many heal from PTSD. Select trauma-focused approaches such as eye movement desensitization and reprocessing (EMDR) and cognitive processing therapy (CPT) give way for a person to process their experiences. Yet, interventions such as these are quite different from more traditional person-centered therapy.

3. Physical Health Problems

Particularly when anxiety has had a sudden arrival, ruling out physical causes is essential. A host of physical health challenges ranging from thyroid challenges to heart disease can sometimes be associated with anxiety-like symptoms. Seeing a physical health provider will be necessary to access treatment for these conditions.

4. Bipolar Disorder

When anxiety is cyclical and associated with other symptoms such as very high energy, uncharacteristic impulsivity, lack of need for sleep, or grandiosity, ruling out symptoms of bipolar mania/hypomania may be necessary. This is especially true if there is a family history of bipolar disorder. Anxiety is common in bipolar disorder. In addition, research suggests that 45% of people with bipolar disorder may also have an anxiety disorder (Pavlova et al., 2015).

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Psychotherapy, along with psychiatric interventions, can be key in the treatment of bipolar disorder. Psychotherapy focusing on sleep and routine stabilization, such as interpersonal social rhythm therapy and cognitive behavioral therapy (CBT), is commonly used. In addition, many with bipolar disorder utilize medication to assist.

In Closing

While anxiety disorders are common, several difficulties other than anxiety disorders can present with anxiety. Ruling out these additional conditions is central to obtaining the most successful interventions. Unfortunately, misdiagnosis of generalized anxiety or missing challenges that tend to tag along is common and can delay effective treatment causing more distress and lost experiences. Anxiety, whether caused by an anxiety disorder or another condition, can be a dreadful experience, yet recovery is possible.

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