Compulsive skin picking, OCD and fear of flying are all linked to the same problem: anxiety. So what can be done to help? 

Have you had a customer who was worried about what to do about the skin they had been persistently picking? Or met a person whose fear of flying was casting a dark cloud over thoughts of their summer holiday?Diverse as these two problems sound, they both stem from the same human emotion – anxiety – and anxiety, says the charity the Mental Health Foundation (MHF), is on the rise.

It is, says the MHF, one of the most common mental health problems in the UK, and the more anxiety a person feels, the more likely they are to experience diagnosable anxiety disorders, including obsessive behaviours, phobias and panic. The MHF’s recent report, Living with Anxiety, highlights increasing levels of anxiety in Britain. Nearly one in five people feel anxious a lot or all of the time, according to new data included in the report, from a YouGov survey of more than 2,000 adults in Britain. Yet it is thought that many people don’t seek help for even significant levels of anxiety.

This is partly to do with people not recognising that they have anxiety, which is, after all, something that we all experience from time to time. Persistent anxiety, however, can start to have a serious impact on a person’s life.

“Anxiety serves a function – it alerts us to things we need to be concerned about,” explains Paul Swift, an associate of the MHF and author of the report. “But if we understand anxiety as being part of our natural make-up, it is difficult for us to realise when that anxiety tips into something that becomes intrusive or negative. So it’s not surprising that people often find it difficult to recognise anxiety themselves.”

Another issue is people not knowing where to go for help. “Traditionally, GPs haven’t been very good at recognising anxiety, but this is changing now, with better training and more awareness,” says Paul. Some people may experience anxiety for years before getting help. “People can live with anxiety or anxiety-related disorders for a whole lifetime,” says Paul. “It may start in childhood as, for instance, a social anxiety, and it may then be magnified as that person goes on through life.”

Here are some anxiety-related disorders and advice on what to do about them:

OCD

Many people have moments where they wonder whether they have locked the front door or switched off the oven, but if someone has obsessive thoughts that worry away at them and carry out repeated actions (called ‘rituals’ or ‘compulsions’) to try to quell those anxieties, they may have obsessive compulsive disorder (OCD).

There are lots of different forms of OCD, explains clinical psychologist Dr Jacquie Hetherton. “For instance, some people with OCD may have a belief system in place that dirt is dangerous. This thought system will lead them to carry out compulsive behaviours to protect themselves against germs – such as excessive cleaning.”

Other forms of OCD can include upsetting thoughts. “OCD can be very wide-ranging,” says spokesperson for the charity OCD Action, Olivia Bamber. Some people with OCD can have very intrusive thoughts, including, for instance, thoughts about causing harm to close family members – thoughts that they of course don’t act on, but which are disturbing and intrusive.”

OCD is believed to affect between one and two per cent of the UK population, but misunderstanding about what it is and worries about being judged are both obstacles in the path of people seeking help for it. There is, says OCD Action, an average delay of 12 years between onset of OCD and treatment. The good news is that it can be successfully managed, but it is important that people with OCD understand that they can be helped. “OCD can ruin lives, it can be so debilitating,” says Olivia. “If someone is showing signs of OCD, they should get help before it worsens and before it takes over.”

Treatments for OCD include cognitive behavioural therapy (CBT), which is often given with exposure and response prevention (ERP). “This is where the therapist will help the client confront their fear,” says Olivia. “For instance, if the client gets recurring worries about whether they have turned the oven off, the therapist will help them to deny the compulsion to go and check and, with time, the anxiety decreases. CBT and ERP together will help a person to be their own therapist, so that they have the skills to help themselves next time an obsessive thought appears.”

Skin picking

A disorder that is related to OCD is compulsive skin picking (CSP). Skin picking is often repetitive, according to the charity Anxiety UK, and may be carried out with fingernails, teeth, tweezers, pins or other implements. “CSP can start when someone is having an anxious time and become a habit,” says Lynne Frederick, vice chair of the charity No Panic. “There will be a trigger – for all anxiety disorders, the root cause is anxiety. Skin picking is a compulsion or ritual that reduces the anxiety, but only temporarily.”

For both CSP and OCD, Lynne recommends relaxation and breathing techniques to help gradually reduce the rituals and compulsions. “We also use exposure therapy and CBT,” she says. “CBT works really well for OCD and CSP. It helps people to recognise that their thoughts are anxiety-related and that they don’t need to act on them.”

Generalised anxiety disorder

Also known as ‘chronic worrying’, generalised anxiety disorder (GAD) is where a person is in a constant state of anxiety, so no sooner do they succeed in suppressing one worry than another one pops up. It is thought to affect one in 25 people in the UK and is more common in those aged 35 to 55. If anxiety is affecting daily life or causing distress, a visit to the GP is advisable.

Fear turned to phobia

Having a strong feeling of fear or anxiety about certain situations or things is called ‘phobia’. It is possible to have a phobia of almost anything, but common phobias include fear of flying, needles and dentists. Treatment, says Dr Hetherton, is gradual exposure to the feared situation or object as well as challenging any irrational thoughts surrounding it. About one in 10 people in the UK are thought to experience fear of flying. “The fear may stem from feeling out of control, being in a cylinder up in the air or a person worrying that they may panic while they are on a flight and not be able to get off,” says Dr Hetherton.

Some people find they suddenly develop a fear of flying, having flown happily for years. “It will have a trigger, though this will be different for everyone – it could be lifestyle, stress or trauma,” says Lynne. “It may be that a person is anxious about something else and, with the wrong interpretation, anxiety transfers to [a phobia of] flying.” Treatment, says Dr Hetherton, is about challenging these beliefs. “For instance, showing the statistics about flying being the safest form of transport. It would also involve learning relaxation techniques, familiarising oneself with an airplane interior and eventually going on a flight.” Fear of flying courses are available, too.

People with dental phobia may well avoid going to the dentist because of their fear, even if they are in pain or have an infection. “Dental phobia can be linked to fear of not being in control,” says Lynne. “Some people have a dental phobia because they have had an awful experience at the dentist and that will stop them going back – they would rather neglect their teeth than see a dentist, even if this means that they build up dental problems which will result in the need for extensive dental work, but they can’t rationalise this to themselves.”

“Treatment for dental phobia,” explains Dr Hetherton, “is about realising that it is survivable, focusing on relaxation and going to an understanding dentist.”

 

 

Signposting:

• Mental Health Foundation: 08457 90 90 90
• OCD Action: 0845 390 6232
• Anxiety UK: 08444 775 774
• No Panic: 0800 1388889