Who is affected by Generalized Anxiety Disorder (GAD)?

Both adults and children can develop GAD, though the condition may look different

depending on age. For example, children may worry excessively about school

performance or family issues, while adults may worry about job security or health.

Women are more likely than men to be diagnosed with GAD. In some cases, symptoms

may emerge or intensify during pregnancy or the postpartum period, adding additional

layers of emotional and physical strain.

Understanding Generalized Anxiety Disorder: More Than Everyday Worry

Most of us worry from time to time — about work, relationships, finances, or health. But for some, worry becomes a constant, overwhelming presence that interferes with daily life. This is the reality for people living with Generalized Anxiety Disorder (GAD).

What Is Generalized Anxiety Disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), GAD is characterized by excessive anxiety and worry that occur more days than not for at least six months. Unlike the occasional bout of stress or nervousness, the worry in GAD is persistent and difficult to control.

People with GAD often find their anxiety interfering with key areas of life — whether it’s work, school, or personal relationships. The condition is more than mental; it has physical symptoms too.

Common Symptoms of GAD

Those affected by GAD may experience:

• Muscle tension

• Restlessness or feeling "on edge"

• Irritability

• Difficulty concentrating

• Sleep problems (trouble falling or staying asleep)

These symptoms can be exhausting and make even small daily tasks feel overwhelming.

Scrupulosity: Understanding Moral and Religious Obsessions

Scrupulosity is a lesser-known subtype of Obsessive-Compulsive Disorder (OCD) characterized by

excessive worry about religious or moral issues. Individuals with scrupulosity

experience intrusive thoughts (obsessions) that they have done something morally or

spiritually wrong, often accompanied by compulsive behaviors aimed at reducing the

resulting anxiety.

Religious Scrupulosity

Religious scrupulosity involves intense fear of violating religious rules, offending a

higher power, or failing to live up to spiritual standards. These obsessions can occur

across all faiths and have not been shown to affect any one religion disproportionately.

Common fears may include:

• Committing a sin or blasphemy

• Going to hell or eternal punishment

• Becoming possessed or spiritually corrupted

• Doubting one's faith or salvation

Moral Scrupulosity

Moral scrupulosity shares the same obsessive-compulsive structure but is not necessarily tied to religion. Instead, it revolves around ethical and moral standards—either internal (personal conscience) or external (social norms).

Common concerns include:

• Fear of being dishonest or unethical

• Obsessive worry about accidentally hurting others

• Anxiety over breaking even minor rules

• Intrusive thoughts that are judgmental, immoral, or cruel

Common Compulsions in Scrupulosity OCD

To reduce the anxiety triggered by these obsessive fears, individuals may engage in compulsive behaviors such as:

• Repeating prayers excessively or in a specific "correct" way

• Repeatedly confessing perceived wrongdoings

• Constantly seeking reassurance, especially from religious leaders or moral authorities

• Ritualistic cleaning or purification practices

• Self-punishment or acts of penance to "make up" for perceived wrongs

While these behaviors may appear outwardly devout or morally conscientious, they are often symptoms of OCD and can interfere with a healthy spiritual or ethical life.

Treatment for Scrupulosity OCD

The most effective treatment for scrupulosity is Exposure and Response Prevention (ERP) therapy, a specialized form of Cognitive Behavioral Therapy (CBT). ERP helps individuals gradually confront feared thoughts without resorting to compulsive rituals, reducing anxiety over time.

When religious or spiritual themes are central, and with the individual's consent, involving a trusted faith leader or clergy member in the treatment process can be especially helpful. These figures can assist in:

• Clarifying doctrinal misunderstandings

• Differentiating between genuine spiritual beliefs and obsessive fears

• Supporting recovery without compromising faith

Symptom Accommodation in OCD and Anxiety Disorders

When someone we care about struggles with OCD or an anxiety disorder, it’s natural to want to help ease their distress. Often, this leads to something called symptom accommodation—changing our behavior to reduce their anxiety in the moment and reduce a person's immediate distress. While this comes from a place of love and empathy, it can actually make things worse over time.

Symptom accommodation means doing things to help someone avoid their anxiety triggers. It might feel like the right thing to do at the moment, but it can unintentionally keep the anxiety going.  While accommodation may offer short-term relief, it can unintentionally reinforce and sustain the disorder over time.

Here are some common examples:

• In OCD: Family or friends might help with rituals like excessive hand washing, cleaning, or checking. They might also answer the same reassurance-seeking questions over and over.

• In Social Anxiety: A loved one might step in to order food, make phone calls, or speak for the person in social situations to help them avoid discomfort.

• In Generalized Anxiety (GAD): This can look like constantly reassuring someone, making decisions for them, or offering extra details to calm their worries—even if those worries are unlikely.

Why It’s a Problem
Although symptom accommodation is common and often well-intentioned, it can hinder long-term recovery. While these actions can reduce anxiety in the short term, they often reinforce the idea that the person can’t cope with anxiety on their own. Over time, this can make the symptoms stronger and more difficult to manage.

That’s why it’s important to address it directly and include it as part of a comprehensive treatment plan.

Cognitive Behavioral Therapy (CBT) can help individuals and their families recognize and gradually reduce accommodating behaviors. This therapeutic approach encourages more effective ways to cope with anxiety—by facing feared situations rather than avoiding them—ultimately supporting lasting recovery.

What is Hit-and Run OCD?

Hit-and-Run OCD is a subtype of obsessive-compulsive disorder (OCD) characterized by a persistent fear of accidentally hitting or killing someone with a vehicle while driving. Individuals with this condition experience intrusive thoughts or mental images of having harmed a pedestrian, despite having no evidence that an accident occurred.

These distressing thoughts can make driving—especially in crowded environments such as city streets, parking lots, or construction zones—particularly anxiety-provoking. Even normal occurrences, like driving over a bump or pothole, may trigger intense fear that someone was run over.

In response, individuals often engage in compulsive behaviors to reduce their anxiety. These may include repeatedly checking mirrors, retracing their driving route, or scanning news reports for car accidents. Many also seek reassurance from others or mentally replay their drive to search for signs that they might have caused harm.

These compulsions can make driving a time-consuming and emotionally exhausting task, often leading to tardiness or missed responsibilities. In more severe cases, individuals may avoid driving altogether. Although these behaviors are intended to prevent a feared outcome, they ultimately reinforce the OCD cycle—making driving increasingly difficult over time.

“Just Right” OCD

"Just Right" OCD is characterized by the persistent need to achieve a specific feeling of completion or correctness. Unlike other forms of OCD, which are often driven by a fear of harm or danger, this subtype is marked by an intense discomfort when things don’t feel “just right.” For individuals with this condition, moving forward in daily activities may be nearly impossible without engaging in compulsive behaviors aimed at achieving a particular sensation of order or balance.

This type of OCD is often linked to perfectionism or the need for things to feel complete. The core fear is not one of external danger, but the internal anxiety of feeling unsettled or “off.” The individual might think, “I won't be able to focus or feel comfortable unless I make things just right.”

In some cases, the compulsions can be body-focused. This is often referred to as Tourettic OCD, where the person feels discomfort or tension in a specific area of the body and is compelled to engage in certain movements to relieve that feeling. For example, they may feel the need to adjust their posture or move in a particular way to rid themselves of this sensation.

Other common compulsions may include repeatedly going in and out of doorways, turning lights or faucets on and off, repeating words or phrases, tapping or touching objects, re-reading or re-writing text, rewatching or relistening to media, and frequently picking things up and putting them down. These repetitive behaviors are not just minor annoyances; they can significantly interfere with a person’s daily life, affecting their performance at school, work, and in social interactions.

Ultimately, individuals with "Just Right" OCD often find themselves stuck in a cycle of compulsions, unable to move forward or engage in their daily routines until they feel that specific, elusive sensation of "rightness."

Emotional Contamination in OCD

Emotional contamination is a form of OCD that falls under the contamination subtype. In this presentation, individuals fear they may become "contaminated" not by germs or dirt, but by a person, place, object, or even an idea. This often involves a feeling of internal or mental contamination that is deeply distressing.

Triggers for emotional contamination can vary widely. Some people fear they might take on unwanted personality traits, like laziness, or physical characteristics, such as a disability. Others may feel contaminated by thoughts related to death or bad luck, such as attending a funeral, walking through a cemetery, or encountering certain "unlucky" colors or numbers.

In some cases, emotional contamination is linked to past painful or traumatic experiences. Individuals might avoid people, places, or items connected to those memories. Sometimes, the contamination is experienced as a vague negative feeling, and the person fears spreading this feeling to things or people they care about. For example, they may avoid their favorite video game, TV show, or important life events out of fear that these will become "ruined" with a negative association.

Common compulsions can be repetitive behaviors or mental rituals—to try to get rid of the contaminated feeling or "essence." These compulsions might look like traditional contamination behaviors, such as frequent hand washing or changing clothes after being near someone or something they associate with contamination. Other common compulsions include trying to "neutralize" a negative thought with a positive or neutral thought, or repeating specific rituals to undo the distressing feeling.

Emotional contamination can be especially confusing and distressing because it’s often invisible to others and difficult to explain.

Disgust Related Contamination in OCD

Some people with OCD experience a type of contamination concern that’s more about disgust than fear of getting sick. In these cases, the worry isn’t, “What if I get seriously ill from this?” but rather, “What if I never feel clean or okay again because this feels so disgusting?”

The main struggle is with the intense and uncomfortable feeling of disgust itself. To try to get rid of that feeling, individuals often perform compulsions—like excessive washing, avoiding certain places or objects, or needing things to feel “just right.” These actions aren’t meant to prevent harm, but to avoid or relieve the emotional discomfort caused by disgust.

The treatment for disgust will focus on helping individuals acknowlege and accept the feelings that the emotion of disgust causes.

It’s important to know that feeling disgusted sometimes is normal. But for those with OCD, the response is often much stronger and harder to manage.

Contamination OCD

The subtype of OCD known as contamination OCD is characterized by frequent and distressing intrusive thoughts related to dirt, germs, illness, bodily fluids or other feared forms of contaminants. Dirt, germs, and bodily fluids are often a trigger for individuals struggling with fear of getting or spreading illness. An individual may be afraid of contracting a life-threatening illness themselves or spreading an illness to others and being responsible for harm coming to them. The COVID-19 pandemic has made these fears even more challenging for many struggling with OCD. Other common obsessions in contamination OCD are fear of contact with chemicals and the fear of contact with parasites causing an infestation. Frequently, individuals report fear of contracting and spreading bed bugs or lice.

Common areas of avoidance with contamination OCD are crowded public places, public restrooms, health care facilities, being around young children, the elderly, or individuals with compromised immune systems, and using public transportation. Those struggling with contamination concerns may engage in compulsive behaviors such as excessive grooming routines, frequent hand washing, barrier use, excessive use of household cleaners or sanitizers, checking or inspecting items for signs of contamination, throwing away items for fear of exposure to contamination, and frequent reassurance seeking from others around cleanliness or safety.

See future blogs for details on disgust and emotional contamination.

OCD Subtypes

The DSM - 5 classifies OCD as having recurrent and persistent intrusive thoughts, images, or impulses (obsessions) that cause an individual significant distress. The obsession is then followed by compulsive actions or thoughts aimed at prevention of the distress or feared outcome associated with the obsessions. While the DSM - 5 does not specify specific subtypes, there are several known common subtypes of OCD.

Subtypes of OCD include contamination or concerns with germs/ cleanliness, aggressive or harm related fears, religious or moral concerns (scrupulosity), perfectionism, excessive concern with responsibility, sexual or taboo obsessions, and “just right” OCD. While these are some of the more common presentations of OCD, this is not an all-encompassing list. OCD may present itself in vastly different ways from individual to individual.

Regardless of the subtype of OCD, cognitive behavioral therapy and exposure and response prevention treatment (ERP) have been shown through empirical research to be the gold standard of treatment. However, understanding some of the unique differences in presentation between the subtypes may help guide treatment interventions. While some compulsions may be similar across various subtypes such as reassurance seeking and avoidance. Other compulsions may be more common to specific subtypes such as hand washing and barrier use in contamination OCD or praying and confessing in scrupulosity. Even within subtypes symptoms can vary significantly between individuals. Through clinical interviews and OCD specific assessments, such as the YBOCS symptom checklist, a mental health professional can help an individual narrow down their OCD presentation and develop an individualized treatment plan targeting their symptoms.

See future blogs for details specific to common subtypes.

www.iocdf.org

Panic attacks vs anxiety attacks and Panic Disorder

Panic attacks and anxiety attacks are often used synonymously however there are subtle differences that make these experiences different.  The biggest difference between the two is panic attacks often happen unexpectedly and suddenly while anxiety attacks are in response to a certain trigger and build up gradually.  Both are associated with uncomfortable physical symptoms such as racing heart, change in breathing, shaking, chills, nausea and sweating.  Panic attacks are quite common, with about 11% of people in the United States reporting at least 1 panic attack in a year.  Females are 2x more likely to experience panic attacks than males.  Most panic attacks peak within 10 minutes with majority of sufferers reporting panic attack symptoms lasting between 5-20 minutes however some attacks can be longer.  Researchers are unsure why panic attacks happen however some research suggests a dysfunction in the amygdala which is the part of the brain that processes fear.  While other research suggests chemical imbalances in GABA, cortisol and serotonin.  Risk factors for experiencing a panic attack include: a family history, co-occurring mental health conditions and adverse childhood experiences (ACES). Those with a family history of panic attacks are 40% more likely to experience a panic attack than those with no family history. 

For some, experiencing panic attacks will lead to a further diagnosis of panic disorder.  Not everyone who has panic attacks will qualify for panic disorder diagnosis however a trained clinician will use the DSM-5 -American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) criteria to assess the individual.  According to the DSM, panic disorder occurs when the individual has had multiple, unexpected panic attacks, usually without warning.  The attacks must also not be associated with another mental health or physical condition.  In addition to experiencing panic attacks the individual must also have a persistent worry for more than a month regarding having another panic attack which results in the individual changing behaviors in order to avoid situations that may trigger another attack. The most effective form of psychotherapy for panic disorder is Cognitive Behavioral Therapy (CBT) with exposure therapy (ERP). An individual can also make lifestyle changes such as avoiding caffeine, alcohol and smoking as well as exercising regularly, eating healthy and managing stress effectively.  With treatment, most people will be able to successfully manage their panic attacks leading to less impairment.  Though panic attacks are not physically harmful, if left untreated panic disorder can result in decreased quality of life and impairment in social functioning.  

https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms#part_6101

Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) is characterized as a person who has excessive and uncontrollable worry. It can feel like a sense of dread or general fear something bad could happen. People can worry excessively about current real issues or future oriented problems that may never happen. Common themes of worry are about health, safety, finances, relationships or performance. Children can worry about academic or athletic performance, relationships with friends, or the safety of themselves or their loved ones. It is common to see those with GAD having chronic headaches, stomach aches or muscle aches, many have difficulty sleeping and find worry can be worse when it’s time to fall asleep or the middle of the night.

Worry used to be thought of as a personality trait, we often hear “I’m just a worrier” but research has shown that it is cognitive phenomenon that can be impairing to one’s life when it becomes too much. When it starts to interfere with one’s daily functioning and increased suffering, it’s important to recognize this as a mental health condition that can be treated with CBT.

See link to take you to the Anxiety and Depression Association of America page to learn more about GAD.

https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

Obsessive Compulsive Disorder

OCD is characterized by and individual having a cycle of obsessions (unwanted, intrusive thoughts, images or impulses that trigger distress) and compulsions (behaviors or thoughts that one uses in attempt to reduce fear, anxiety and distress caused by obsessions).

Many people will have times in their life where they have obsessions and/or compulsions, but that does not mean they have OCD. Those with OCD spend excessive amounts of time in their disorder and it will interfere with activities of daily living, important activities and reduce quality of life.

 It can occur at any age, but often will present at 8-12 years old, or late teen-early adulthood.

While many people have ideas on how OCD can present itself, there are numerous subtypes of OCD with variations on the symptoms one may have; Contamination, Responsibility, Sexual, Violent, Religious/moral, Real Event or false memories, Identity, and Perfectionism are some more common themes.

www.iocdf.org

Cognitive Behavioral Therapy

Cognitive Behavior Therapy (CBT) is a treatment modality, working to identify how thoughts(cognitions), emotions and behaviors relate to each other while then making adjustments to your behaviors and thoughts to treat many mental health problems. Goals of CBT can be to learning to identify and recognize how one’s thinking errors/cognitive distortions can lead to one’s behaviors, and vice versa, leading to a developed plan to make changes to improve one’s quality of life.

Exposure and Ritual Prevention (ERP) is the specific form of CBT that is utilized to treat anxiety disorders. Research has found it to be the most effective for the treatment of anxiety disorders*. CBT has also been show to be effective for many other mental health concerns.

 All clinicians at the Center for Anxiety Disorders are trained and utilize CBT as the main treatment modality with their clients.

*Abramowitz JS. Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: A quantitative review. J Consult Clin Psychol. 1997;65:44–52. Abramowitz JS. The psychological treatment of obsessive-compulsive disorder. Can J Psychiatry. 2006;51:407–16).

Anxiety or Anxiety Disorder?

We all have anxiety; it’s is a biological activation of our nervous system to keep us safe, from real or perceived danger. So, then what makes it a disorder? When an individual has impairments or dysfunction as a result of the symptoms from anxiety, it becomes a disorder.

An individual with an anxiety disorder will experience event that triggers a thought that activates a fear, they will then engage in a variety of different behaviors to try to control and reduce the thoughts, fears and physical sensations that arise from an activating incident. As these thoughts, fears, sensations and behaviors increase over time, it becomes a problem when an individual sees impairments and harm to their functioning as a result.

Yes, we all can say we feel anxiety as that is a normal part of human life, but it is important to know the difference between the common feeling and when it becomes impairing to an individual.

Our clinicians will be able to help you identify and diagnose an anxiety disorder, then develop a treatment plan to help you reduce your symptoms, impairments, dysfunction and suffering.

The Center for Anxiety Disorders: Who are we?

The Center for Anxiety Disorders is a group of highly trained clinicians who specialize in the treatment of anxiety disorders using Cognitive Behavioral Therapy, with an emphasis on Exposure and Ritual Prevention — or ERP. We are located in Brookfield, WI and serve all of the Milwaukee-metro area.

ERP is empirically validated as the treatment of choice for anxiety disorders*, with the goal of reducing symptoms and not just learning how to manage anxiety. Our therapists are trained to develop an individual treatment plan made for our patient’s specific symptoms of anxiety, as no two patients present the same. We utilize ERP for the treatment of Obsessive Compulsive Disorder, Social Anxiety Disorder, Panic Disorder with and without Agoraphobia, and Generalized Anxiety Disorder.

*Abramowitz JS. Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: A quantitative review. J Consult Clin Psychol. 1997;65:44–52. Abramowitz JS. The psychological treatment of obsessive-compulsive disorder. Can J Psychiatry. 2006;51:407–16).

Coming soon!

We’re excited to share that our therapists will begin contributing to our blog soon. Stay tuned!