Sometimes I worry my GAD could actually be Pure-O - what's the difference?

[Sparkle1984]

Whenever I've been to the doctors for help with my anxiety, I've always been diagnosed with GAD and never OCD. Yet sometimes I worry "What if it is actually Pure-O?"

I don't have any compulsions, apart from the compulsion to ruminate on whatever topic is worrying me at the time. Whenever I have an anxiety episode (my episodes tend to last for a few months before they fizzle out), it tends to be about a specific theme, and involves a lot of rumination about that subject. Here is a quick summary of the themes I've had during my anxiety episodes:

9 years old – I went through a month of what I now realise was derealisation. I felt like everything was unreal and dreamlike. I remember obsessing over the feeling and worrying about whether it would ever go away.

10 years old – I got water in my ear when washing my hair one day, and I didn’t feel it come out again. This sparked an obsession with my hearing – I was worried that my hearing in my right ear would be permanently damaged and kept trying to check it, and I also noticed a buzzing sound in my ears which really scared me (it’s still there, but it doesn’t bother me anymore). This episode lasted a couple of months and I also felt derealised at times.

12 years old – I noticed these red pin-prick spots had started to form on my skin (mainly on my arms and legs). I was worried that it could be a sign of some serious disease, or that my whole body would end up covered in them. This obsession lasted for 2 to 3 months, and was worse than my previous episodes. I also felt very derealised and started obsessing about my heart-rate for the first time.

19 years old – I developed an obsession about solipsism (worrying that I was the only person in the world and everything/everyone else is a figment of my imagination). I was also obsessed about other philosophical subjects related to this. This episode was accompanied by severe derealisation and lasted for about 3 months before it gradually fizzled out.

23 years old – I developed an obsession about time (I was worried about whether it speeds up as you get older) and this led on to an obsession about death and dying. This was my most severe episode to date. It lasted 8 months and I had almost all of the common anxiety symptoms and also felt depressed.

28 years old – The main theme was death and dying, although it was different to the episode I had when I was 23. At first, the obsession was about my parents getting old and dying, then it moved onto me getting older and eventually dying. I started getting thoughts like “What’s the point in anything if we all end up dying anyway?” I started to get very depressed. This was when I first sought help from a doctor for my anxiety, and was diagnosed with GAD.

29 years old – A few weeks after my withdrawal from citalopram, my anxiety came back in full force. It was the same theme as last time – ageing, death and dying. After about 6 weeks it had got so bad that I went back to the doctor’s and asked to restart my meds.

31 years old (my current episode) - Worrying about what my life will be like in the future, including worries about dystopian themes and philosophical subjects outside of my control. Sometimes the thoughts about death and dying are there, but they're not the main focus this time around.

It was only from my 20s onwards that my anxiety episodes began to be accompanied by the more severe physical symptoms, such as insomnia, loss of appetite, depression, apathy, jitteriness etc, which are common with GAD.

I was just wondering, as each anxiety episode is focussed around a main theme, does that mean my anxiety is more likely to be Pure-O than GAD, and would that have any bearing on what I need to do in order to recover? I've often been confused about the exact difference between GAD and Pure-O, so that's why I wonder if it's possible to be mis-diagnosed.

[MyNameIsTerry]

Hi Sparkle,

The difference is that OCD needs to become a problem enough in itself to warrant a diagnosis. This is because many of the traits in OCD can be seen in other anxiety disorders and as well as in normal life. For instance, my dad checks the locks and double presses light switches but he isn't anxious and it doesn't interfere with his life so he doesn't have OCD. I used to do the same as a child and put the pen tops back on a few times but I didn't feel anxious and it went away hence not OCD (it's common in childhood and to grow out of it as I did).

So, it would need to be significant enough to be impacting on your life. Is it?

I know what you mean though, I am only diagnosed with GAD but thats because my GP is lazy and has obviously not read any of the reports from the therapist he referred me to who spotted it in her initialy session when I didn't realise myself what was happened to me as I had only had GAD for the first 5 years.

In terms of recovery between GAD and OCD, yes and no. There are many things that can be done to both but some things may need a more specific strategy e.g. a compulsion may need ERP to get you limiting yourself to doing it less & less but this might not be relevant to someone with GAD. Things like acceptance, positive thinking, changing negatives, Mindfulness, challenging thoughts, etc are going to work across the board.

I would say that what stands out in your post to me is probably more the solipsism. This is a Pure O form but you need to remember that solopsism can be seen across any anxiety disorder too. It's going to be a question of whether it is strong enough in terms of impact on your life to warrant a diagnosis.

Having said all that, learning about OCD is not a bad thing. A fair amount of your concerns are about the future, health, death, lack of control, etc so how we deal with things like intrusive thoughts for instance are going to be very relevant to you (they would be to someone with HA too).

[Sparkle1984]

Thanks for your reply, Terry. I don't really have any compulsions apart from the compulsion to ruminate about the worries, so I'm not sure if ERP would be useful for me.

Whenever I read about other people's Pure O intrusive thoughts, a lot of them seem rather different to mine - for example, I never get thoughts about harming others/myself, or thoughts that I may do something bad. I am practising techniques like acceptance, challenging thoughts, and mindfulness, so hopefully that will help.

[MyNameIsTerry]

Hi Sparkle,

Pure O sufferers tend to have mental rituals instead such as testing themselves against their fear to check they react how they expect they should or they seek reassurance or confess things even if they don't need to, etc.

Intrusive thoughts can take various themes e.g. solopsism (as you mentioned above), sexually themed, religion, harm, fear of developing things like HIV/AIDS, fear of developing more serious mental illness, etc.

I've had harm ones mostly about my parents and strangers. I dealt with those years ago. Since lasy year I started having some about losing my mind and harming myself. I found they were tied to my adrenaline spikes which come in cycle and I think may be connected to my meds. I handle them though, I've been through it before so I keep reducing it.

ERP can be useful across the range of anxiety disorders, it's just a component of CBT anyway so it's only if you need it. I just wanted to answer your question about strategies for both. CBT for both is really the best treatment eitherway. Some people need more Cognitive Restructuring which fits into the Cognitive Therapy end and some need more like ERP which fits into the Behavioural Therapy end.

It seems for you that rumination is a big problem as solopsism easily triggers that one in people and you mentioned that when a theme comes up you will ruminate on it. So, it's not like with intrusive thoughts where you are triggered into a compulsion, the rumination is really the compulsion because rumination is indulged in as opposed to resisted like intrusive thoughts where a compulsion is needed to mitigate. To be honest, intrusives cause rumination anyway like people with POCD who may then spend hours searching through their past for examples of potentially "doggy" behaviour.

I think what you are doing currently is the best thing you can do because it's about gaining control over your mind again so that you can dismiss the thoughts as nothing and move on as opposed to get stuck and spend times overthinking. Mindfulness will be a great tool for this as staying in the present as well as being an observer to your thoughts is exactly what you need more of so it doesn't go running away with itself. I hope it helps you.

[TomT]

Hello Sparkle, I can really relate to your topic.
You said it yourself you don't have the same compulsions as Pure-O users not even the same kind of thoughts.
So take a deep breath and trust yourself