Obsessive-compulsive disorder is characterized by persistent thoughts, ideas, or images (obsessions) and by repetitive, purposeful, and intentional behaviors (compulsions) that a person performs to manage his or her intense distress. To qualify as obsessive-compulsive disorder, the obsessive thoughts and compulsive behaviors must be time-consuming and sufficiently distracting to interfere with the person's ability to function in employment, academic, or social situations. Patients with cancer who have a history of obsessive-compulsive disorder may engage in compulsive behaviors such as hand washing, checking, or counting to such an extent that they cannot comply with treatment. For such patients, normal worry about the cancer diagnosis and prognosis can develop into full obsessive-compulsive symptoms and be severely disabling. Obsessive-compulsive disorder is most often managed with serotonergic antidepressant medications (selective serotonin reuptake inhibitors and clomipramine) and cognitive-behavioral psychotherapy. This disorder is rare in cancer patients who do not have a premorbid history.
Posttraumatic Stress Disorder
Posttraumatic stress disorder is diagnosed when a person re-experiences a traumatic event with intrusive distressing recollections, dreams, flashbacks, or hallucinations. Though definitions of a traumatic event have been focused on those outside the range of normal human experiences (e.g., military combat, torture, and natural disasters), the diagnosis of a life-threatening illness now meets criteria for a traumatic stressor. Additionally, the experience of hospitalization and/or some painful treatment may also reactivate traumatic memories. Cancer patients who have posttraumatic stress disorder can become very anxious before surgery, chemotherapy, painful medical procedures, or dressing changes. Anxiolytic medications given in preparation for treatment can foster adjustment and reduce distress. No specific medications, however, have been consistently demonstrated to be the most effective or have been studied in other populations of patients with posttraumatic stress disorders; psychotherapy remains the treatment of choice. (Refer to the Posttreatment Considerations section and refer to the PDQ summary on Post-Traumatic Stress Disorder for more information.)
Generalized Anxiety Disorder
Generalized anxiety disorder is characterized by ongoing, unrealistic, and excessive anxiety and worry about two or more life circumstances. Some examples are patients' fears that no one will care for them even though they have adequate and willing social support and the fear of exhausting their finances even though adequate insurance and financial coverage is available. Frequently a generalized anxiety disorder is preceded by a major depressive episode. A generalized anxiety disorder is characterized by motor tension (restlessness, muscle tension, and being easily fatigued), autonomic hyperactivity (shortness of breath, heart palpitations, sweating, and dizziness), or vigilance in scanning (feeling keyed-up and on-edge, irritability, and having exaggerated startle responses).
Anxiety Disorder Caused by Other General Medical Conditions
Possible Causes of Anxiety*
*Adapted from Massie.
|Medical Problem ||Examples|
|Poorly controlled pain||Insufficient or as-needed pain medications.|
|Abnormal metabolic states||Hypoxia, pulmonary embolus, sepsis, delirium, hypoglycemia, bleeding coronary occlusion, or heart failure.|
|Hormone-secreting tumors ||Pheochromocytoma, thyroid adenoma or carcinoma, parathyroid adenoma, corticotropin-producing tumors, and insulinoma.|
|Anxiety-producing drugs||Corticosteroids, neuroleptics used as antiemetics, thyroxine, bronchodilators, beta-adrenergic stimulants, antihistamines, and benzodiazepines (paradoxical reactions are often seen in older persons).|
|Anxiety-producing conditions ||Substance withdrawal (from alcohol, opioids, or sedative-hypnotics).|