Anxiety and Intrusive Thoughts

Hi! I am very anxious and since I was little I can say my doubts and fears controlled my life. These fears and thoughts I have are totally absurd.

When I had surgery it was hard to eliminate because of the anesthetic and the nurse told me that I will get sick and forced me to use the toilet even though the anesthetic hadn’t totally passed. I forced myself to pee and I got scared by doing it and this fear continued for a while even if I started having kidney pains.
I did not take any treatment for these problems. As absurd as it may seem.. it’s real. How can I stop thinking like that and what’s my problem?? I need an answer. (From Romania)

Thank you for writing to us here at Psych Central. What you are describing is very hard to categorize and this is by no means a diagnosis. I’m going to refer you to a clinical psychologist or a psychiatrist who can ask the many other questions that would be needed to answer this adequately.

That being said the situation causing the anxiety and the intrusive thoughts are often signs of Posttraumatic Stress Disorder (PTSD). Again, there can be many other possibilities, but this would be the rule-out diagnosis.

PTSD is seen as more generally coming from a chronic mental and emotional stress that happens as a result of a deep psychological shock that most often disturbs sleep, with a constant recollection, usually with vivid detail of the shock or injury that’s taken place. (To learn more about PTSD, please read here.)

It is possible that you being made to do what you didn’t want to do under the influence of the anesthesia may have qualified as a traumatic event — even though the nurse was trying to help.

Since PTSD might be at the core of what you’ve been dealing with I’d like to offer some suggestions for approaches that have been successful with PTSD. They fall into 3 general categories: Psychotherapy, medication, and self-help. The various forms of psychotherapy are:

• Trauma-focused cognitive behavioral therapy (CBT)
• Cognitive processing therapy (CPT)
• Cognitive therapy (CT)
• Prolonged exposure (PE) Eye movement desensitization and reprocessing (EMDR)
• Brief eclectic psychotherapy (BEP)
• Narrative exposure therapy (NET)

Often prescribed medications are selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft), and the selective serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor). Your physician or Nurse Practitioner is the right person to talk to about which of these might be best for you.

Self-help recommendations supported by research are — exercise. acupuncture. Yoga, workbooks, and social support. For an excellent discussion on these and other treatment option please read Margarita Tartakovsky’s article here.

The important thing is for you to get an accurate diagnosis from a qualified professional. If this confirms what has happened is PTSD then you can more on to treatment. Until then any of the above self-help approaches are likely to be beneficial whether or not the condition is PTSD or something else.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

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