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Expert Q&A

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Could anxiety disorder cause my husband to imagine things?

Asked by Iris Moton, East Chicago, Illinois

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My husband has generalized anxiety disorder, and he always seems to bring up something he says he has seen me do or something I supposedly said when I cannot recall that ever happening. So my question is, can GAD cause a person to worry so much about something that he believes it happened?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

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Dear Iris,

I've been thinking about your question for quite awhile. Generalized anxiety disorder does not typically make people believe something happened when it hasn't. GAD is primarily a state of chronic, mostly constant, worry about daily things combined with chronic physical anxiety symptoms, such as chest pain, shortness of breath or a churning stomach.

If your husband is not just giving you a bad time but really is struggling with feelings or beliefs about things happening that didn't happen, there are really only a couple of possibilities. The first possibility, which I suspect doesn't fit your husband, is that a person is psychotic. In many ways, this is the essence of psychosis: strong conviction about things that everyone else would not believe to be true. For example, years ago on the psychiatric ward, we had two patients that believed they were Jesus Christ. One day, I pointed this out to one of the gentlemen and asked him to explain how there could be two Jesuses. Without missing a beat, the fellow told me, "That other guy has schizophrenia!"

The other condition that makes people feel very strongly that things have happened when they haven't is obsessive compulsive disorder, or OCD. I often tell psychiatric residents that OCD is one of the two great pretenders in the psychiatric world, by which I mean that it can mimic many other conditions. The essence of OCD is being barraged by thoughts -- typically disturbing -- that cannot be controlled. These thoughts (or obsessions) often lead to repetitive actions aimed at easing the thoughts (compulsions). The classic example is the person who can't stop worrying about dirt and germs, so he or she washes hands over and over again until they bleed. When people's minds are swamped by these repetitive thoughts (which they typically recognize as being irrational), all sorts of other things often follow: insomnia, depression, anxiety, bizarre behavior that can appear psychotic, and drinking and drugging to ease the psychic pain. Because people are often embarrassed about their obsessions, they will frequently hide them, making diagnosis all the more difficult.

Although germs and hand washing are the most stereotypical OCD symptoms, the disease can lead to fixation on almost anything. I had a patient once whose life was hamstrung because he kept thinking about how change might fall out of his pants pockets. One of the most tragic OCD cases I ever had was a young mother who wouldn't touch her baby because she couldn't stop thinking about -- and visualizing -- how she might drop her child on the floor.

A very classic OCD symptom is to worry that one has done something bad or dangerous. For example, people with OCD will sometimes stop driving because they keep worrying that they've hit someone by the side of the road whenever they drive past a person. I had another patient that quit driving because she would become so convinced she might have hit someone that she couldn't go 20 miles without turning back multiple times to check for bodies by the side of the road. Another classic symptom of this type is feeling like one has said or done something to upset or insult other people. OCD patients will often spend hours trying to remember and replay everything they did and said during the day to check for this. When this symptom is severe, people can convince themselves that they've offended others, which leads to the compulsion of constantly checking with others and asking for forgiveness.

So if the things your husband worries about happening seem obsessive, repetitive and overblown or illogical, you might want to think about OCD. The bad thing about OCD is that it quietly ruins many people's lives. The good thing is that it is eminently treatable with medications and a special type of psychotherapy called variously exposure-response prevention, or extinction, therapy. If your husband has OCD, having him get help would profoundly improve your lives together.

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