As a longtime therapist in private practice who also has spent a decade teaching Abnormal Psychology, I am sometimes struck by the collision of the two worlds. In the latter role, I teach undergraduates the full range of psychological disorders housed in the Diagnostic and Statistical Manual of Mental Disorders (or DSM-5), focusing on the signs, symptoms, and criteria for things like depression, anxiety disorders, substance abuse, trauma, and eating disorders. As a licensed clinical psychologist who actually treats these disorders, however, I am often reminded that real human beings rarely fit into diagnostic boxes perfectly. Although many of my clients may suffer from disorders that present in classic ways, there are often additional angles that are unique—thoughts, feelings, and behaviors which they feel are so strange that they can't tell anyone else. Ironically, when someone feels alone and ashamed of something about themselves, that distress can often make a problem even worse.
Read on for some surprisingly common situations that may not have an official "diagnosis," but can be helped by therapy all the same.
1. Intrusive Thoughts That Are Out of Character
Maybe you constantly visualize punching your boss in the face, or are troubled by your frequent urges to get in the car and drive miles away from the life and family you know, leaving it all behind. Often, our distress about intrusive thoughts is just as much of a problem as the thoughts themselves—this pattern can eventually take on the characteristics of the more serious Obsessive-Compulsive Disorder. But whether it’s technically diagnosable or not, a skilled cognitive-behavioral therapist can help identify the roots of these thoughts and develop a plan of action to remove their grip on your life, whether by challenging them, diffusing them, or even learning to coexist with them by changing your mental reactions when they happen.
2. Overfocusing on Your Appearance or How You Are Perceived in Public
Body Dysmorphic Disorder occurs when a person is so preoccupied with the flaws they perceive in their physical appearance that it takes over their life, and it can often lead to excessive cosmetic procedures, extremely low self-esteem, and even reclusive behavior. Much more common, yet less talked about, are the lower-level concerns that nag at people's thoughts each day: Are you always worried about where to look when you're talking to someone? Do you hate the way you walk, or overthink your words, or tuck your hair behind your ears so often that it seems like a tic? Many times, people are inside their own head so much about their social interactions that they can start to feel trapped, even if they don't actually meet the diagnostic criteria for Social Anxiety Disorder or Body Dysmorphic Disorder. Cognitive-behavioral techniques with the help of a professional can help you break out of this cycle.
3. Fears You're Embarrassed to Tell Anyone Else
Most of us understand what phobias are — the category is referred to as "specific phobias" in the DSM-5 — and we may picture a person having a panic attack when looking out a window from the 50th floor, or screaming like a banshee when they see a spider. But while fears of heights, bugs, enclosed spaces, or getting blood drawn are well-known, fewer people talk about fears that seem more strange, like: Getting your foot caught in an escalator. Mayonnaise. Clowns. Patterns of tiny holes. Accidentally hitting someone with your car. Such fears may seem like trivial quirks, but they can cause a lot of distress, which is sometimes made worse by worries about their being odd. Thankfully, the same types of Cognitive-Behavioral Therapy techniques that can address more classic phobias can be just as helpful for atypical fears. The part that makes it harder is being willing to take that first step of discussing those fears out loud.
4. Behavior You're Ashamed Of
Have you gotten into a pattern of screaming at your kids when you’re alone? Has your usage of a certain type of pornography gotten out of control? Are you secretly drinking more than others realize, feeling trapped in a cycle of online gambling, or developing bodily habits that are usually associated with preschoolers? Perhaps you’ve even betrayed someone close to you and feel like you are living a lie. Naturally, behavior that we’re ashamed of or harbor a lot of guilt about is often the last thing that we want to admit to out loud. But that can make our anxiety over the behavior grow, turning it into a “thing” — and something that makes us miserable. But in actually talking about it to a professional, you can take the first steps toward change. (And take it from me: It is hard to shock a seasoned therapist.)
5. Being Unable to Let Go of a "Minor" Event in Your Past
Do you still replay in your mind something embarrassing that happened in high school? Are you constantly cringing about an ignorant comment you made six months ago? Do you repeatedly fall into a desperate wish to redo some relatively minor incident in your past that everyone else has long forgotten about? Of course, you may be embarrassed that you even ruminate on these things, creating layers upon layers of self-consciousness that go far beyond the original event itself. But why allow this cycle to take up mental space and emotional energy? Help in breaking out of dysfunctional thought patterns is one of the most basic benefits of therapy. And no matter how big or small the original event that you’re dwelling on, a skilled therapist can help you break out of its hold.
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Andrea Bonior, Ph.D., is a licensed clinical psychologist, best-selling author, and keynote speaker. She is the voice behind the Baggage Check mental health advice column in the Washington Post Express, and serves on the faculty of Georgetown University. Join the conversation on Facebook.