ôô

3 Anxiety-Related Disorders You Might Not Know About

Some psychological disorders fly under the radar, but they're no less real for the people who suffer from them—celebrities and fictional characters included. Here are three anxiety-related disorders you may not have heard of.

By
Jade Wu, PhD
6-minute read
Episode #271
anxiety disorder
The Quick And Dirty
  • In addition to the common types of anxiety that we all experience, such as worry or social anxiety, there are some uncommon ways that anxiety can manifest.
  • Selective mutism is when a person has a very hard time speaking in certain situations even though they have no language deficits.
  • Body dysmorphic disorder is where a person is overly preoccupied with a "flaw" in their appearance.
  • Trichotillomania is a disorder where a person repeatedly pulls hair from their own body, usually to relieve stress and tension that builds up before they pull. 
  • In all of these cases, treatment should focus on understanding the underlying difficulties with emotion regulation, and helping the person to have better coping strategies and more confidence.

Most people know what it’s like to feel anxious. That tension in your muscles, those butterflies in your stomach, and the drumming of your heart tells you that you’re not calm. And this is totally normal. Where would we be if genuinely dangerous situations like dark alleys at night didn’t give us the heebie-jeebies? And would we take important tasks very seriously if we didn’t get nervous in the spotlight, like when giving a wedding toast?

Sometimes, anxiety goes too far and gets in the way of our everyday functioning. It can mess up our health, relationships, work, and fun. It’s not hard to imagine the pain of being plagued by non-stop worries or feeling so shy as to have trouble with dating. But sometimes, anxiety and anxiety-related processes can show up in more unusual ways, even ways that don’t seem at first to have anything to do with emotions.

The Diagnostic and Statistics Manual - 5th Edition is the official American Psychiatric Association’s list of psychological disorders. It’s a huge bible detailing everything that’s considered a disorder and how it’s categorized. It takes experts years to update it in response to ongoing scientific findings.

Sometimes, anxiety goes too far and gets in the way of our everyday functioning. It can mess up our health, relationships, work, and fun.

The Anxiety Disorders section got a big makeover in the last update, which came out in 2013. It’s now split into a few different sections, including Trauma and Stress-Related Disorders and Obsessive-Compulsive Disorders. Some of the less common disorders got shuffled around, some got new names, but experts still agree that the line between categories is blurry at best. Overlapping and related to some of the most common anxiety disorders, such as generalized anxiety disorder and social anxiety disorder, are some that are less well-known.

Let’s talk about three little-known disorders related to anxiety. They’re rare, but for those who have them, they’re very real and disruptive. We’ll take a look at what they are, where they come from, and how they might be treated.

1. Selective Mutism

If you’re a fan of The Big Bang Theory, you’ll already have some idea about selective mutism. Raj, the beloved astrophysicist at CalTech, speaks perfectly fine … except when it comes to talking to women. This character is one of the rare adults with selective mutism, an anxiety-related disorder where someone consistently fails to speak in certain situations despite being able to speak in others.

Adults who used to have selective mutism are more likely to still have some anxiety disorder after they grow up.

This disorder is usually found in childhood, often starting between the ages of 2 and 5 when children go to daycare or preschool for the first time and fail to speak outside of their home. It’s a pretty rare disorder, occurring in less than 1 percent of children. They usually grow out of it, though adults who used to have selective mutism are more likely to still have some anxiety disorder after they grow up.

How selective mutism is treated

So, Raj from The Big Bang Theory represents a very small percentage of adults with any symptoms of selective mutism. Eventually, by the end of Season 6, he and his friend Penny accidentally discover that he’s gotten over it after a tough breakup. Good for him!

But usually, heartbreak is not the treatment of choice for selective mutism. The treatment with the strongest scientific support is Cognitive Behavioral Therapy—a structured, hands-on, short-term treatment that aims to change the person’s behaviors and thought patterns. For kids with selective mutism, a therapist would help them to work up a ladder from their easiest to hardest speaking situations by giving lots of encouragement and praise. I bet that would have helped Raj, too!

2. Body dysmorphic disorder

Michael Jackson has a complicated story and controversial legacy. No matter your opinion of the man, you may not know that some experts believe he may have had symptoms of body dysmorphic disorder (BDD). This is a psychological disorder where someone is very preoccupied about an aspect of their appearance that they think is flawed, even though others don’t notice it or don’t think it’s a major problem.

A sufferer of BDD ends up spending a lot of time and effort checking the perceived appearance flaw, trying to change it, covering it up, or getting others’ reassurance about it. This can cause problems for people because they’re spending hours checking and “fixing” their appearance. They may avoid socializing or otherwise let their anxiety about their perceived deformity get in the way of their relationships.

A sufferer of body dysmorphic disorder ends up spending a lot of time and effort checking the perceived flaw, trying to change it, covering it up, or getting others’ reassurance about it.

Sometimes, a person with body dysmorphic disorder gets plastic surgery to fix the perceived deformity. In fact, 7-15 percent of people who get cosmetic surgery have BDD. Unfortunately, surgery doesn’t solve the problem permanently—it only provides temporary relief before some new flaw and new preoccupation worms its way into the person’s mind and they feel compelled to do even more surgery to “fix” the new problem.

This is why some believe Michael Jackson had BDD—he seemed to have engaged in a large number of surgeries that drastically changed his appearance, and there did not seem to be a stopping point.

How is body dysmorphic disorder treated?

The solution is not to change the person’s appearance. After all, by definition, the supposed flaw is greatly exaggerated in the sufferer’s mind compared to how other people view it. Both medications and psychotherapy can help by relieving the root of the anxiety that drives the vicious loop of anxiety and preoccupation. The goal is to break the cycle of intense focus on the "problem" body area that drives up the anxiety, which only gets reinforced by the relief that constant appearance-checking, seeking reassurance, and plastic surgery bring.

3. Trichotillomania

Trichotillomania is not only a difficult word to say, but it also represents a mental health disorder that is often hard to recognize. It is a disorder where a person has overwhelming urges to pull hair from their own body, usually from the scalp, eyebrows, or eyelashes.

Those who experience trichotillomania say there’s mounting tension before pulling, or when they’re trying to resist pulling. They feel a big relief or even a sense of pleasure when they do pull the hair out. Some simply throw the hair away, while some play with or even ingest the hair as part of the pulling ritual. These symptoms can cause problems for people if the hair-pulling results in noticeable hair loss, takes up a lot of time, or causes embarrassment that gets in the way of their normal life.

You may be surprised to hear that there are famous and attractive people who have trichotillomania. Olivia Munn, Charlize Theron, and Justin Timberlake have all talked publicly about having this disorder. In the general population, 1-3 percent of people have it, and it occurs most often in women. Usually, it starts in the early teens but can continue into adulthood for many years.

Who is at risk for developing trichotillomania and why? As with most psychological disorders, the answer isn’t straightforward. We do know that people with a family history of trichotillomania are more likely to have it themselves, and they’re also more likely than the average person to have other anxiety disorders. Experts believe that the hair-pulling itself may be a way that people cope with stress and negative emotions like sadness, boredom, stress, and frustration. The problem is that the relief they feel from pulling makes them do it more, but also creates shame and guilt, leading to a vicious cycle.

How is trichotillomania treated?

To climb out of the cycle of hair pulling, habit reversal therapy plus medications seem to be the most promising treatment approach. Habit reversal therapy involves weekly psychotherapy sessions where people learn skills, including self-monitoring, emotion awareness, and stimulus control—ways of setting up the environment to make themselves less able to pull, such as wearing gloves.

Because trichotillomania isn't really about hair, just like body dysmorphic disorder isn't really about someone's nose and selective mutism isn't really about language, it's important to address the underlying issues that keep the engine of the disorder turning. Negative emotions, and most importantly, difficulty recognizing or coping with these negative emotions, are the real fuel for this engine. In the cases of these uncommon anxiety-related disorders, this fuel not only activates the body's natural anxiety but also takes away our confidence in our ability to sit with anxiety and survive negative emotions. Once we learn to trust ourselves again, we can take power back.

Medical Disclaimer
All content here is for informational purposes only. This content does not replace the professional judgment of your own mental health provider. Please consult a licensed mental health professional for all individual questions and issues.

About the Author

Jade Wu, PhD

Dr. Jade Wu is a licensed clinical psychologist. She received her Ph.D. from Boston University and completed a clinical residency and fellowship at Duke University School of Medicine. Do you have a psychology question? Call the Savvy Psychologist listener line at 919-533-9122. Your question could be featured on the show.