The Three Bears: Anxiety, OCD, Depression
We all fear being labelled and when you first encounter a mental health disorder it is easy to become very distressed about what you will be classified with. It is certainly an ongoing sign of the stigmatization of mental illness that some terms are socially ‘preferable’ to others.
When it comes to anxiety and depressive disorders, it has been my experience as a coach that clients will seek reassurance that they are not ‘X’, rather than simply accepting their clinicians view. This is particularly true in my experience of working with people who are anxious and I will regularly be asked, ‘Do you think I’m depressed?’ Or even more commonly; ‘I’m worried that I have OCD.’
The truth is that the questions that are being asked are a lot more complex than they may appear. In physical medicine you typically have a single diagnosable condition which, (despite potentially leading to other conditions), is in itself distinct. In psychological diagnostics things are a little less clear as several diagnosable illnesses may present together.
Guy Goodwin’s excellent article in ‘Dialogues in Clinical Neuroscience’ identifies the fact that diagnostics have largely been driven by the ‘Lumpers’ and the ‘Splitters’. The lumpers tend to look at the similarities between symptoms of disease, whilst the splitters focus on their differences and therefore classify them separately. The Diagnostic Statistical Manual 5 has taken a more ‘splitter’ approach and as a result anxiety, OCD and depression all sit in different chapters, which perhaps offers a greater level of separation than many people experience in practice.
Before we go further in discussing obsessional thoughts in anxiety, I do want to reiterate that psychiatrists, psychologists and doctors are experts in defining the unique features of a persons’ mental ill-health. Whilst we may get hung up on the diagnostic label we are given, it is very often just the headline (or primary presenting feature) to them and there is a far more tailored and comprehensive diagnosis behind it.
At the same time, from the patient and client supporting perspective I often wonder if it wouldn’t help individuals to understand some of the common groupings of features in their diagnosis. I certainly remember the confusion I felt about my Generalised Anxiety Disorder (GAD) diagnosis in 2005. I began to tell people that I had been diagnosed with an anxiety disorder, which whilst initially made sense, I definitely felt quite depressed early on in my recovery. Then latterly as my panic and acute anxiety began to fade, I began to identify obsessional thoughts that seemed to trigger a lot of my anxieties.
The Three Bears
Over many years of supporting and advising Christians with similar diagnoses to myself, I haven’t met a single one that had a purely anxiety-based experience. I have come to refer to Anxiety/Depression/OCD as ‘The Three Bears’. A person’s diagnosis is commonly defined by ‘Daddy Bear.’ In my case anxiety. Mummy bear is the second most prevalent feature whilst baby bear is the least significant feature. My ‘Three Bears’ are Anxiety-OCD-Depression. Of course, I may just be a natural ‘Lumper’ and I am sure there are a few ‘Splitters’ out there who would disagree with me!
So, what’s the point of this discussion? In part it is to encourage you not to get over focussed on the specific headline diagnosis you are given. If you are already anxious, it is natural to start worrying that you have either got the wrong diagnosis or that your doctor has missed something and that only creates more anxiety.
Secondarily, I think that it is helpful to carry a level of expectation and openness to the appearance of features of your illness that may carry a different label. I think I may have done better earlier on if I had been told, “Look Will, you have an anxiety disorder but you may well feel quite low for a while and you may also experience some OCD style thinking. That’s all quite normal and all of these issues will be positively impacted by the medication we are giving you…”
Finally, I have found great benefit to my anxiety levels through actually addressing ‘Mummy Bear’. Whilst OCD has always been a secondary feature in my anxiety disorder (and it is all internalised) treating it with Exposure and Response Prevention techniques and cognitive labelling has reduced my anxiety levels overall. I think if I hadn’t been able to accept OCD as part of my diagnosis, I would have missed out on a key part of my recovery.
Suffice to say; you are ‘fearfully and wonderfully made’. Your mind is uniquely complex and requires a relatively tailored approach to recovery. Try not to let your anxiety shut-down your curiosity to the breadth of your psychological experiences. God is with you in all of this and his revelation is often the precursor to his restoration.
Will Van Der Hart, 13/05/2021