OCD - Obsessive Compulsive Disorder/Obsession of cancer

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QUESTION: I am 47 and had been battling the health anxiety since 20 years. I have hypertension,hyperlipidemia & mitral valve prolapse with trivial regurgitation (which causes anxiety & palpitation). All these years my focus was mainly on heart, but since one month i has become very cancer phobic, as i remember one of aunt who died of cancer before 15 years..

I asked whether anxiety can cause cancer, so one allexperts counselor replied me that, anxiety & depression does not cause cancer, but cancer can cause depression. I don't know under what context she said that, which made my life like a living hell.

I know that, anxiety & depression does not cause cancer.

But Now i am fearing & obsessing that, depression is the symptoms of cancer.

What i know is that, upon being diagnosed with cancer, the patients become depressed, anxious & sad.

I have seen the people having depression for 30+ years & living with it & they don't have cancer.

Half of the world has depression, if depression would be the symptom & then half of the world would have cancer.

If somebody is depressed, when he will go to psychiatrist for treatment, will the psychiatrist will tell him to go & test for cancer.

This obsession had made me more fearful & i am having full blown continous panic attacks since 2 weeks. The anxiety is 10 out of 10 since i read that answer. I unable to function & get up from
the bed. I am not going to work since one week & unable to sleep since one week only obsessing that, cancer causes depression & it is becoming vicious cylce.

All these years i know that, panic & anxiety symptoms are harmless & i never bothered about these symptoms,only afraid for the first few years when i was not aware.

Due to continue ongoing challenges of health anxiety & mitral valve prolapse i have anxiety & palpitation. Now, every time when i feel anxious or depressed, i am thinking it is due to
cancer.

Please help me. I will be grateful to you. Give me some cognitive tips to challenge this negative thoughts. It is killing me. My body is full of adrenaline & burning. Hyper alert 24 hours.

With the help of even a small stick in between the sea will be enough for me to come out this fear trap.

ANSWER: Hi Afzal,

Thanks for your question. Sorry to hear about your experience with health anxiety over the years.

There is no causal relationship between cancer and depression. This logic is like saying, that there's a causal relationship between waking up and brushing your teeth. Sometimes one leads to another. But they are very separate processes. Someone with cancer may feel upset and go through stages of grief, but the cancer didn't make them be depressed, it is generally how they thought about their cancer and their level of coping skills that might lead to that outcome. We know that the way we think and feel about ourselves can lead to depression; but there's no causal link between cancer and depression. This is why, as you say, if someone develops depression, they are not sent away for cancer testing. Because they are two very different medical problems.

But it's not particularly wise to give you reassurance about the focus of your obsessions (surrounding health issues and cancer). You do seem to exhibit obsessive-compulsive ways of thinking, which seem to be primarily obsessional, or what we sometimes call "Pure O". Reassurance tends to actually make these kinds of obsessions worse, because it only relieves anxiety for a short while, and you begin to expect more reassurance in the future. The next time someone says something that alarms you or makes you feel anxious, you will have little choice but to make "sure" of what they meant to say, and in what context they said it, to feel better and safe again, and because you did it before and it seemed to work in relieving your anxiety. This is called reinforcement, and your brain begins learning that the only way to deal with these unpleasant, negative thoughts & feelings (and indeed panic attacks), is to go and find reassurance.

In order to successfully treat your obsession, you will likely need to look into appropriate OCD treatment by a trained therapist. This will focus on how you respond to your thinking, and cutting down rituals in Pure O, which are often covert "mental rituals" that you might not be aware of. And any overt  behaviours that you engage in, like reassurance-seeking. They will probably prescribe you a medication that will help ease the burden of anxiety symptoms and panic attacks.

I wish you luck. If you have any followup questions or comments, feel free to share them.


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---------- FOLLOW-UP ----------

QUESTION: Thanks for your response, which had helped me immensely.

Now, sometimes of the day i started to think very absurdly or i am forcefully force to think regarding my cancer obsession.

Any wrong thing will cause me cancer, like if i abuse i will get cancer,if i see to any girls with bad intention i will get cancer, if i do any thing unlawful i will get cancer, if i eat from the ill goten money i will get cancer, if i skip the duty without informing my boss then i will get cancer etc.

This was not the case previously for 20 years regarding the obsession related to heart etc.

Before i used to get this type of thinking but only sometimes & not very severe, such as, if i was jogging & suddenly i will think if i stop jogging till i reach to that point, i will not get heart attack or heart disease. if i clear the signal in one go then, i will not get the heart disease or heart attack.

What to do to counter this negative/catostrophic/intrusive thoughts which force/compell me to do certain things.

i know it is not good to do anything illegal or immoral, but i don't want to do such things to get prevented from cancer.

I am taking cipralex 10mg for my anxiety, which to much extent has brought down anxeity to the manageable level. Should i add abilify with it or take klonopin, when i feel very severe cancer obsession.

Answer
Hi Afzal,

In your followup you asked:
"What to do to counter this negative/catostrophic/intrusive thoughts which force/compell me to do certain things."
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What we have found with OCD over the decades, is that challenging or countering your thoughts is not only unhelpful, but can make your obsessions worse - this is because they end up being part of the problem, rather than the solution.

They end up being rituals, or compulsions - because these are the actions you decided to take in your past that at least temporarily helped to relieve your anxiety over unpleasant thoughts. The behaviours you exhibited in the past, now contribute to the behaviours you feel you should/must engage in now. And the reason they are so compelling, is that various areas in your brain expect you to perform this behaviour in order to feel that relief again.

You need to re-train your brain to understand that by not responding to these unpleasant thoughts, you will still be alright - the anxiety will subside by itself, and you will be okay. In order to do this, you will need to cease behaviours that attempt to mitigate your obsessional anxieties. These may be more thoughts (mental rituals), or actions you take (like seeking reassurance). Below I'll provide you a brief but good starting point to approaching your obsession, but seeing a therapist will probably help even further.

Sorry, I don't give advice on which medications to take. Please consult your doctor about that. I wish you very good luck!


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I often recommend that OCD patients follow this acronym: ERP-AA. This stands for Exposure & Response Prevention - Acceptance & Awareness.

Exposure is based on the proven principle of habituation. That our anxiety declines in the presence of a stimulus, (mental or environmental), if we give it enough time & frequency (i.e. practice, how many times we do it), and we cease our escape or avoidance behaviours. In OCD - the behaviours are centered around achieving relief to escape the unpleasant feeling of anxiety that accompanies certain kinds of thoughts - and also the strong feeling like something's "wrong", "needs fixing", or needs attending.

Response Prevention is based on the idea that behaviours you decide to perform now will affect behaviours you wish to perform in the future. In order to break this OCD behavioural cycle between anxiety and compulsive urges in the future, we need to decide to cease those behaviours now, in the present. Both during and outside of exposures.

Acceptance means we do not try to supress or counter or struggle with our thoughts and feelings. In acceptance we acknowledge that struggling against these thoughts and feelings can actually make them worse. Struggling against them can build up the problem, leading to extreme obsessiveness, panic attacks, and chronic anxiety.

Awareness, as applied to the acronym ERP-AA, is both a state of attention - mentally observing something - and understanding. In awareness we simply take a moment to observe that we're having an unpleasant thought. But then we also understand that "a thought is just a thought", a "feeling is just a feeling"; thoughts and feelings are not facts about you or the world. They are merely physical and mental phenomena that do not directly engage in the real world. We understand that feelings change and if we act appropriately towards our OCD now, things will get better. Learning more about OCD, why we do not need to respond compulsively to unpleasant thoughts and feelings, can help to increase the power of this understanding in your awareness - and one day help free you from your OCD!
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OCD - Obsessive Compulsive Disorder

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Alan Baker

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I can answer questions relating to OCD, such as:

*Washing
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Please note: I can not give you a diagnosis or give you medical advice. I also do not offer therapy or counselling. I advise you to see a doctor or mental-health professional for appropriate treatment of OCD.

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I've been a research associate in clinical psychology, written numerous essays on OCD diagnosis & treatment, and been quite active in the local OCD community (as we do group-therapy and workshops). I also consider myself an ex-sufferer of OCD.

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B.A Science
PGDip Applied Psychology
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