An understanding of anxiety often eludes us because it is so multifaceted, and you will discover how complex many of these faces can be in the next section. This process can be so confusing precisely because it is so normal to maintain a certain degree of anxiety, just as we all need a certain blood pressure in order to maintain consciousness. Like blood pressure, anxiety is nec-essary for our survival. Anxiety can also present as a subpiece of many different clinical pictures, thus making it a challenge to distinguish what is primarily anxiety and what is primarily another mental disorder with an anxious feature.
For example, a provider never knows when initially treating someone dependent on alcohol how much internal anxiety serves as the primary driving force behind her alcoholism. Depression, manic depression, or a genetic predisposition to addiction and alcoholism can serve equally as motivations for drink-ing. In a classic example, a patient might present to the office complaining of overwhelming anxiety and panic attacks but also experience a psychotic break with reality consistent with a first onset of schizophrenia. Understandably, the feeling of losing your mind— knowing that your mind does not work as before—can produce anxiety that feels overwhelming.
However,anxiety would not be the primary illness at hand, though it would be a critical component of the picture. Rick’s comments: Because I am coping with depression as well as with OCD, I do find it difficult to figure out which causes which, if, in fact, one diagnosis has led to the other. Certainly, being depressed at times could have triggered my desire for greater control over my environment, which OCD pro-vides at least the illusion of achieving.
On the other hand, not being able to leave my bed without repeating a particular phrase first, or doing so with a series of words that cycle and recycle in my head from the moment I’ve woken up can be depressing. I’m trying to control things by doing something that makes me feel totally out of control! On the other hand . . . well, it’s confusing. If I had to guess, I would say that the depression came first, however I would-n’t be surprised if I simultaneously also had OCD, too, without realizing it, or recognizing the symptoms at that time as being symptoms.