Hello
Your OCD has improved significantly, which is encouraging. Sometimes, when one set of symptoms improves, underlying anxiety becomes more noticeable rather than representing a completely new illness.
Your symptoms are most suggestive of:
* Social anxiety disorder – especially if you fear being judged, appearing unintelligent, or embarrassing yourself around people you perceive as smarter. * Residual OCD – if the fear is driven by obsessive doubts (e.g., “What if they realize I’m not intelligent enough?”) and compulsive mental checking or reassurance-seeking. * Less commonly, Generalized anxiety disorder or low self-esteem may contribute.
Since you are already taking Fluoxetine and Clomipramine, these medications can also be effective for social anxiety. However, if your symptoms remain severe after more than 6 months, your psychiatrist may consider optimizing the dose, adjusting medication, or focusing therapy more specifically on social anxiety.
I recommend discussing these new symptoms with your treating psychiatrist. They may ask whether your fear is mainly about negative evaluation by others (favoring social anxiety) or whether it involves intrusive obsessive thoughts and compulsions (favoring OCD), as this helps guide treatment.
In the meantime, continue therapy, avoid avoiding social situations, and practice gradual exposure to conversations with people you find intimidating, as this is one of the most effective treatments for social anxiety.
Take care
Hello It’s great to hear about your progress with OCD and the significant reduction in your symptoms! The fear and anxiety you experience around people you perceive as more intelligent could indeed be related to social anxiety, but it might also stem from feelings of inadequacy or low self-esteem in social situations.
Possible Conditions: 1. Social Anxiety Disorder: This involves intense fear or anxiety in social situations, particularly when you feel judged or evaluated by others. It can manifest as fear of embarrassment or being perceived as less competent. 2. Performance Anxiety: This is a specific type of social anxiety where you fear being evaluated in situations that require you to perform or demonstrate your abilities. 3. Impostor Syndrome: This is a psychological pattern where you doubt your accomplishments and have a persistent fear of being exposed as a “fraud,” often feeling inadequate compared to others.
Medications: - Clomipramine and Fluoxetine: Both of these medications are SSRIs (Selective Serotonin Reuptake Inhibitors) and are often used to treat OCD and anxiety disorders. They can be effective for social anxiety as well, but individual responses can vary. - Consultation: It might be beneficial to discuss your current symptoms with your prescribing doctor or a mental health professional. They can assess whether your current medications are sufficient or if adjustments are needed.
What You Can Do: - Cognitive Behavioral Therapy (CBT): This can help address the underlying thoughts and beliefs contributing to your anxiety in social situations. - Mindfulness and Relaxation Techniques: These can help manage anxiety symptoms when they arise. - Gradual Exposure: Similar to ERP, gradually exposing yourself to social situations can help desensitize your fear response.
It’s important to keep an open line of communication with your healthcare provider about your experiences and any changes in your symptoms. They can provide tailored advice and support based on your specific situation.
Thank you
Hello dear I think it is probably due to side-effects of ocd medication which causes Bleeding Diarrhea Vomiting Weakness Dizziness Pain Clotting Iam suggesting some tests for confirmation. Please share the result with gynaecologist in person for better clarity and for safety please donot take any medication without consulting the concerned physician Serum ferritin Serum tsh Serum prolactin Serum progesterone Rft Lft CBC Urine analysis Pelvic USG Serum estrogen Serum progesterone Hopefully you recover soon Regards
Hello,
First, I want to acknowledge the excellent progress you have made. Reducing your OCD symptoms from 35 to 7 with ERP therapy, clomipramine, and fluoxetine is a significant achievement.
The fear and anxiety you now experience around people you perceive as more intelligent could be related to social anxiety disorder, especially since it occurs in most social situations and leads you to avoid them. It may also represent residual OCD-related fears (such as fear of being judged, making mistakes, or not being “good enough”), or a combination of both. These conditions can overlap, so it is important to discuss this with your treating psychiatrist or therapist rather than assuming it is a completely new disorder.
The medications you are taking—clomipramine and fluoxetine—can also be effective for social anxiety disorder, but the dose or treatment approach may need adjustment depending on your symptoms. Since you are already in therapy, your therapist can help determine whether your current anxiety responds best to cognitive behavioral therapy (CBT) techniques, continued ERP, or social anxiety–focused exposure exercises.
Prescription / Advice:
Continue taking clomipramine and fluoxetine exactly as prescribed. Do not change the dose or stop either medication without consulting your psychiatrist.
Discuss these new symptoms with your psychiatrist and therapist, as your treatment plan may need to be adjusted.
Continue CBT/ERP, and ask your therapist about incorporating graded social exposure and techniques to address fear of negative evaluation.
Practice gradual exposure to social situations rather than avoiding them completely, starting with situations that cause only mild anxiety.
Maintain regular sleep, exercise, and stress-management strategies, as these can help reduce overall anxiety.
Seek prompt medical attention if your anxiety becomes overwhelming, significantly worsens, or you develop thoughts of harming yourself.
Overall, this is treatable, and many people with OCD also experience social anxiety that improves with the right combination of therapy and, when needed, medication adjustments.
Feel free to reach out again.
Regards, Dr. Nirav Jain Family Medicine Specialist
