Health Anxiety, Phobias & Related Disorders
The wider obsessive-compulsive spectrum, treated with the same tools and tuned to each condition
Around OCD sits a family of conditions that share its machinery, an intrusive fear or urge, a ritual that relieves it, and a loop that tightens with every repetition. Health anxiety, in which reassurance from doctors and the internet becomes the compulsion. Emetophobia, the fear of vomiting, which can narrow a life to a few safe foods and rooms. Complex and long-standing phobias. The body-focused repetitive behaviours, trichotillomania and skin picking. Hoarding disorder. And the generalised anxiety that so often accompanies all of them. I treat these with the same three modalities as OCD, and with the same insistence on an accurate diagnosis first.
- Health anxiety and emetophobia
- Both are driven by intolerance of uncertainty and maintained by avoidance and checking. Exposure-based CBT, including, for emetophobia, graded exposure to the feared sensations and situations, has good evidence; serotonergic medication helps where anxiety is severe. I also look for the OCD, panic disorder or depression that frequently sits underneath.
- Trichotillomania, skin picking and hoarding
- The body-focused repetitive behaviours respond to habit reversal training, the same behavioural approach I use for tics, sometimes with medication for the underlying urge. Hoarding disorder is different again, poorly responsive to standard OCD medication, better to a specifically adapted CBT, and often complicated by other conditions and by risk in the home. It needs a careful, unhurried assessment.
- Complex phobias and generalised anxiety
- Where a phobia has resisted previous treatment, the reason is usually that exposure was never sustained, or that another condition, OCD, autism, trauma, was in the way. I look for it. Generalised anxiety disorder that has not responded to first-line treatment is often OCD or health anxiety in disguise: nearly half of misdiagnosed OCD was first labelled as generalised anxiety.
- What I offer
- A specialist assessment across the whole obsessive-compulsive spectrum; a diagnosis and a written plan; medication where it will help; exposure-based therapy or habit reversal delivered or directed by me; and onward referral where a specialist service is the right next step.
To arrange an assessment
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020 8123 0234 ·
secretary@drhimanshutyagi.com