Worry manifests in a number of different ways. In fact, the way people worry is likely as diverse as people themselves. However, I believe there are three broad categories of worry people engage in: social, obsessive, and general.
Yes, there are multiple variations and permutations of these categories. My goal is not to reduce the complex phenomenon of worry into an overly simplistic concept, but rather highlight how it may be helpful to view worry from a broader perspective. If you are able to approach the concept from the 30-000 foot view it will be easier to understand the individual variations of your clients.
A lot of people are uncomfortable in social settings. For some, it manifests as shyness when out with friends at a club or bar, with family at a party, or out at dinner with work colleagues. The fear of saying something wrong or upsetting someone without meaning to plagues others.
Basically, socially anxious people tend to worry that they will be negatively judged by others in some way. And as a result, they tend to avoid social situations for fear of being embarrassed, ridiculed or shamed (even though it’s unlikely this will happen).
The emotional effects of social worry are not the only effects these individuals experience. They also suffer a number of physical symptoms. Some of the more common ones include:
- Racing heart
- Dry mouth
- Quivering voice
What types of things do socially anxious people worry about? Well, it’s limitless. It could be any number of things. But, in my experience, some of the more common ones include:
- Starting a conversation
- Being rejected by friends, family or strangers
- Talking or giving a speech in public
- Meeting new people
- Entering a room when people are already there (they often like to be the first at the party)
- Making eye contact with a stranger
As you are well aware, unless these issues cause significant distress for the individual and interfere with daily functioning, the symptoms do not reach the level of “disorder.” But when they do, it is apparent and often labeled as social phobia or a related disorder. Specific examples of the type of life disruption typically seen include:
- Starting a conversation- A single, intelligent, and attractive man in his thirties has not been on a date in three years. He has had several opportunities just in the past month to ask a woman on a date who was interested in him. His fear of talking to a stranger prevented him from doing so.
- Rejection- A successful business woman has been unhappy with her job for the last few years. She would like to leave, but has avoided going on job interviews because of her fear that she will be turned down.
- Public speaking- A nurse was recently promoted to an administrative position. One of her new responsibilities is to lead a daily information meeting each morning for the nursing staff. She has decided to resign because of her nervousness about speaking in front of the staff.
- Meeting new people- A woman in her early fifties recently divorced from her husband of 30 years. She would like to begin dating again. She doesn’t because she is afraid the men she meets will think something is wrong with her because she’s divorced.
- Entering a room with seated people- An attractive young woman avoids going to restaurants because she is worried about being judged by those already in the room.
- Making eye contact- A college student avoids leaving her dorm room because she is afraid that she will unintentionally offend someone by staring at them.
Obsessions are persistent thoughts, images or impulses that cause distress for the individual having them. They are unwanted and seem to be uncontrollable by the person. In some cases, the obsessive worrier may engage in compulsive behaviors (checking/re-checking, hand washing, arranging/rearranging items) to reduce the anxiety.
These behaviors work to varying degrees, but do not eliminate the anxious thoughts. In essence, what they do is temporarily relieve the anxiety. Because they work in the short-term they are highly reinforcing and hard to extinguish. As you might expect, this type of worry is typically labeled as Obsessive-Compulsive Disorder. But, not all cases reach the level of disorder and people must learn to manage these different symptoms as part of their everyday life.
The focus of the obsessive worry varies from person to person. But, the most common themes include:
- Aggressive, sexual or religious thoughts or impulses
As with social worry, obsessive worry is only problematic when the thoughts interfere with normal life. Examples include:
- Contamination/Filth-A woman obsesses about catching an illness from door handles, which causes her to no longer leave the house.
- Orderliness/Neatness/Sequencing-A man worries constantly about his tie being crooked, so much that he goes to the bathroom a few dozen times each day to check himself in the mirror. This behavior has caused him to get behind on several projects at work.
- Safety/Harm-A father is consumed with thoughts about something bad happening to his children if he drives even one mile an hour over the speed limit. He dreads driving to and from work.
- Aggressive, sexual or religious thoughts or impulses-A Sunday school teacher has stopped going to church because of uncontrollable thoughts and images she has of herself engaging in sexual activity with the church’s pastor.
What is a general worrier? You guessed it. It is someone who worries just about everything. The worry is seemingly uncontrollable and often not backed up by any apparent evidence. A unique aspect of the general worrier is the amount of worry. In most cases, the amount of worry is in excess of what is warranted.
It is not that the person should not worry or is being completely irrational, it is a matter of the worry being directly out of proportion of what would be expected for the average person. You’re right. If severe enough, this type of worry is typically labeled as Generalized Anxiety Disorder.
The focus of the worry varies from person to person. The most common themes include:
- Health and Safety of Loved Ones
- Family Problems
Remember, it is about the amount of worrying that causes problems not the fact that the person worries. Worrying about finances, family, health, or work from time-to-time is normal. It becomes problematic when the worry interferes with normal life. Examples include:
- Finances-A husband/father can’t sleep at night, pays the household bills late or doesn’t pay them at all or causes conflict in the family because he constantly worries about not having enough money to buy food for his family.
- Health and Safety of Loved Ones-A mother is so consumed with thoughts of her daughter getting sick that the child isn’t allowed to leave the home or normal social activities are severely restricted.
- Marriage/Relationship-A wife constantly worries about her husband leaving her, which drives an emotional and physical wedge between them.
- Family Problems-A teenager stresses daily about whether or not her parents will ever divorce. Consequently, she uses alcohol to relieve her anxiety.
- Injury/Death-A woman worries so much about her elderly father dying that she avoids going to see him. This causes the woman to become depressed.
- Work/School-A college sophomore can’t stop thinking about what type of job he will get after graduation. He’s on the verge of being expelled from school because of low grades.
*This article is adapted from Dr. Moore’s book Taking Control of Anxiety: Small Steps for Getting the Best of Worry, Stress, and Fear.