#362 ‒ Understanding anxiety: defining, assessing, and treating health anxiety, OCD, and the spectrum of anxiety disorders | Josh Spitalnick, Ph.D., A.B.P.P.

What It Covers

Clinical psychologist Josh Spitalnick explains anxiety disorders, focusing on health anxiety and OCD. He covers the four layers of anxiety, distinguishes between thoughts and thinking, explains exposure therapy techniques, and addresses how social media, wearables, and medical record access amplify health concerns.

Key Questions Answered

• •Avoidance as diagnostic threshold: Anxiety becomes a disorder when avoidance behaviors emerge. Worry alone without behavioral changes to reduce distress does not meet DSM criteria for dysfunction. The key distinction separates normal concern from pathological anxiety requiring treatment intervention across all anxiety disorder categories.
• •Mental rituals versus thoughts: Passive thoughts are involuntary, but mental rituals involve active rumination. Questions starting with who, what, where, when, why, how, or what if indicate mental compulsions. Spending time analyzing these questions perpetuates anxiety rather than resolving uncertainty, making mental rituals as destructive as behavioral compulsions.
• •Health anxiety symptom triad: Symptoms fall into three categories: medical requiring intervention, physical without medical basis, and purely psychological. Somatic symptom disorder involves physical symptoms with negative test results. Illness anxiety disorder involves fear of diseases without symptoms. Treatment differs based on which category predominates in presentation.
• •Exposure therapy components: Four types exist: in vivo using real situations, imaginal using written narratives, interoceptive inducing physical sensations like dizziness or rapid heartbeat, and media augmented using videos or virtual reality. Sessions last thirty to forty five minutes without performing safety behaviors, creating corrective learning experiences rather than just habituation.
• •Heritability and environmental factors: Health anxiety shows thirty to forty percent heritability, lower than OCD at forty to fifty percent. Social media, wearable devices tracking biometrics, and instant access to medical records through patient portals significantly increase health anxiety presentations. COVID pandemic doubled general anxiety rates and normalized hypervigilance about physical symptoms.