Fear of stroke

What is stroke related OCD?

The Fear of a stroke is a manifestation of Obsessive Compulsive Disorder within the health concern subtype. This presents in a myriad of ways but is defined by OCD that is predicated on obsessive fears around having a stroke and the symptoms associated with this medical condition. Those suffering from this condition engage in compulsions that attempt to resolve the anxiety created by obsessive fear relating to strokes. These compulsions could range from overt behaviors such as checking heart rate/blood pressure to more covert examples such as reassuring oneself with comforting self talk. Hypervigilance of symptoms associated with stroke, avoidance of media relating to stroke or heart attacks, and behaviors intended to lower the risk of a stroke are all common for those within this subtype of Health OCD. All compulsions will be an attempt to resolve fear or gain certainty around strokes.

Other common presentations for those suffering from this condition would be spending an inordinate amount of time researching the health topic of strokes, seeking reassurance from medical professionals, or thinking about the topic of strokes to a significantly greater extent than peers. The idea that anxiety or thinking about strokes could lead to a stroke is also common in those experiencing Health OCD related to strokes.  

Fear of stroke in OCD – Common obsessions

• What if I might be having a stroke
• What if this increases my chance of a stroke
• Is this a symptom of having a stroke?
• Do I have a family history of strokes?
• Did something I did in the past make a stroke more likely?
• What if I am having a stroke and I do not know that I am having one?

Those suffering from stroke related Health OCD generally are fearful that they themselves will either have a stroke or that they will suffer the consequences of a stroke after surviving the incident. Fears often revolve around symptoms and risk factors associated with stroke.  These symptoms and risk factors are readily available online and are often vague or common enough to be frequently triggering to stroke OCD sufferers. They may constantly test to see if both arms have equal strength, look in the mirror to see if their face is drooping, or talk more than necessary to see if their voice is working or brain is functioning properly. 

Common triggers experienced by people with stroke OCD

• Media presentations of strokes
• Heart racing due to exertion
• Heart racing due to anxiety
• Atypical feelings on a specific side of the body, real or imagined
• Numbness, real or perceived, in a part of the body
• Blurring of the vision
• Misunderstanding someone
• Loss of balance

How can I tell if it’s OCD fears and not anxiety?

There is not a simple way to be sure if what you’re experiencing is a stroke, generalized anxiety, or even just stress. Some signs that discussing OCD with a professional should be considered are as follows:

• If there are repetitive behaviors or thought processes you often will go back to as a means to manage anxiety, that can be a symptom of OCD
• Reassurance from medical professions, research, and self assessment are comforting for a short period of time, but need to be repeated again to feel good. Examples would be needing second opinions from medical professionals, or reading multiple articles on the same topic.

If you find yourself thinking about strokes significantly more than others you know and you do not have a specific reason to fear speaking to an OCD Specialist could be helpful.  

When people with stroke OCD experience intrusive thoughts they may:

• Seek reassurance from healthcare providers or sources of medical information on the internet. 
• Attempt to self assess their health through blood pressure checks, heart rate checks, and other health metric data collection. 
• Research the symptoms and aftermath of a stroke.
• They may also try to learn about those who have suffered from strokes and what their lives were like following the experience. 

Common compulsions performed mentally or physically by people with OCD fear of stroke

• Research
• Reassurance seeking from medical professionals
• Self assessment
• Asking others for reassurance
• Family history research

How to treat fear of stroke

Stroke related Health OCD is highly treatable through ERP with a trained professional. Treatment begins with thorough functional analysis to determine when obsessions are present and what compulsions are used to resolve the resulting distress. Upon identification of obsessions, compulsions, and what triggers them, the clinician and client build a hierarchy of situations that would cause that member distress relating to strokes.  This could start with simply imagining a specific symptom of a stroke or listening to some media referring to strokes. As members habituate to these lower level exposures on the hierarchy, treatment will progress to more challenging exposures.  These could include intentionally increasing one’s heart rate or watching media representations of stroke.  In response to these exposures, members will be supported by the clinician in doing response prevention, or resisting compulsions. Response prevention can begin as delaying compulsions, spoiling compulsions, or striving to do nothing. Clinician and client will always work collaboratively to ensure the client does not become overwhelmed or asked to do more than they are ready for. In this way clients will find that they can choose how they respond to intrusive thoughts, urges, or fears relating to strokes.  

I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

We look forward to working with you.